Cerebral edema is the abnormal accumulation of fluid in any of the tissue compartments of the cerebral parenchyma. It remains a significant challenge in neurotrauma care because it contributes to secondary brain injury, affecting prognosis. This review analyzes the recent literature, including foundational studies, to describe the mechanisms of distinct types of cerebral edema following traumatic brain injury (TBI). Emerging concepts, such as the role of the glymphatic system and heme-derived inflammasomes, offer new insights into new types of edemas, differentiated by pathogenesis and potential treatments. Recent advancements in understanding these molecular mechanisms can improve therapeutic strategies, facilitating a better approach in the era of precision and personalized medicine. Although there has been notable progress, a proposal to customize treatments for diverse types of edemas is necessary to improve outcomes following traumatic brain injury. In this review, we describe the current subtypes of post-traumatic brain edemas and link them to a specific management approach.

Traumatic brain injury (TBI) remains a leading cause of mortality and disability in Colombia and other low- and middle-income countries (LMICs), where disparities in resource availability limit implementation of standardized care. The first edition of BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol), published in 2020, provided guidance for TBI management across variable healthcare settings. Advances in neurotrauma care prompted development of an updated protocol. How can TBI management be optimized across prehospital care, emergency care, neurosurgical surgery, and intensive care phases in settings with varying resource availability? A multidisciplinary panel of 17 national experts in prehospital care, emergency medicine, neurosurgery, and intensive care conducted a structured consensus process using Delphi principles and Nominal Group Technique. Eleven predefined clinical questions were addressed. Recommendations were developed through subgroup work, literature review, and iterative voting, requiring ≥70% agreement at subgroup level and ≥90% plenary consensus. Final algorithms were stratified according to resource availability and healthcare complexity. The second BOOTStraP edition produced 9 integrated management algorithms covering prehospital transport, emergency care, neurosurgical decision-making, and critical care. Interventions are stratified and color-coded by resource requirements, enabling feasible actions in low-, intermediate-, and high-resource settings. Algorithms integrate neuroprotection goals, triage criteria, surgical indications, and monitoring strategies. BOOTStraP provides a pragmatic, phase-based, resource-sensitive framework bridging evidence-based recommendations with real-world constraints. This approach supports context-adapted decision-making and may reduce secondary brain injury while improving standardization of TBI care in resource-limited environments.

Intracranial hypertension is a life-threatening complication of traumatic brain injury (TBI) and a major target in neurocritical care. While ventriculostomy for cerebrospinal fluid diversion and the emerging technique of cisternostomy are used on a regular basis in different areas of the world, their application is heterogeneous on indications, timing, and technical aspects in the surgical procedures. This variability highlights a critical lack of standardized protocols, particularly in resource-constrained environments where optimized recommendations are most needed. What are the specific, expert-consensus recommendations to standardize the use of ventriculostomy and cisternostomy within a protocol for TBI management? The Neurotrauma Committee of the World Federation of Neurosurgical Societies develop an international consensus, including a methodological group and a panel of 16 expert neurosurgeons following a Delphi process, involving systematic literature review, statement formulation, and iterative blinded voting using a 5-point Likert scale. Consensus was predefined as ≥75% agreement. The panel ratified 69 consensus statements. Core recommendations advocate for ventriculostomy as an early therapeutic intervention for TBI requiring fluid drainage and define cisternostomy as an adjunctive procedure for selected patients with TBI and significant traumatic subarachnoid hemorrhage. Protocols with algorithms were proposed for both procedures. This consensus provides a practical framework to guide surgical management of TBI using ventriculostomy and or cisternostomy as techniques. It promotes a strategic shift towards prior heterogeneous concepts on ventriculostomy and defines a specific, consensus-guided role for cisternostomy. The statements aim to harmonize global practice and direct future research.

Purpose: Colombia has established legal frameworks for prehospital emergency medical services (EMS) but has no nationally standardized prehospital triage system. Given a high trauma burden and marked geographic heterogeneity, we aimed to develop a structured, nationally adapted prehospital triage classification framework and describe its design. This article reports a consensus-based development and design study; it describes the framework’s structure and does not constitute a clinical validation. Methods: The framework was developed through a three-phase process: (1) review of Colombian regulatory instruments and international triage literature; (2) structured expert consensus using the Nominal Group Technique with a ≥ 90% agreement threshold across ten virtual consensus sessions, conducted with the technical committee of the Colombian Association of Trauma, Prehospital Care, and Emergency Medical Systems (ACTAEM) and the Meditech Foundation research group; and (3) geographic and operational adaptation to Colombia’s response infrastructure. No patient-level data were collected. Results: The framework defines three operational modalities (information-and-communication-technology [ICT]-mediated dispatch triage; on-scene one-to-one triage; and multiple-casualty-incident triage), a four-level colour-coded priority classification comprising 91 syndromic conditions with objective criteria and defined response-time standards, and a geographically adaptive vehicle-assignment protocol aligned with Colombia’s regulatory vehicle taxonomy. It is designed to be interoperable with Resolution 3100 of 2019 and Resolution 5596 of 2015. Conclusions: We propose the first structured, criteria-based prehospital triage framework adapted to Colombia’s regulatory, epidemiological, and geographic context. It is intended as a structured basis for evaluation and for potential future adoption; prospective validation of clinical outcomes, inter-rater reliability, and implementation fidelity remains the essential next step.

Traumatic brain injury (TBI) patients often exhibit an increase in their intracranial volume due to blood collection or brain tissue edema, affecting the intracranial compliance. When the volume of any intracranial compartment exceeds a critical threshold, the compensatory mechanisms become overwhelmed, compromising intracranial compliance and blood supply, which leads to Intracranial Compartment Syndrome (ICCS). This condition exacerbates brain damage through secondary injury. When less aggressive measures to treat ICCS are insufficient, cranial decompression is recommended, with decompressive craniectomy (DC) currently being the preferred technique. Although its effectiveness has been demonstrated, DC is also associated with a high incidence of complications, including cerebral spinal fluid (CSF) disturbances and surgical site infections. Expansive craniotomy (EC) has been proposed as an alternative that leverages the benefits of cranial decompression provided by DC while reducing the associated adverse effects. The E-SPACE clinical study is a prospective, multicenter, observational, comparative-effectiveness study enrolling adult TBI patients diagnosed with ICCS who require cranial decompression. This multicenter comparative-effectiveness observational study will compare the functional outcomes and complications associated with DC and EC over a 12-month period.

Intracranial compartment syndrome is a common and potentially lethal complication in patients with traumatic brain injury (TBI). It results from an increase in intracranial volume due to hemorrhage or cerebral edema, exceeding compensatory mechanisms and leading to reduced compliance and reduced cerebral perfusion, even in absence of full intracranial hypertension syndrome. This pathophysiological cascade can cause secondary brain damage if it is not identified early since the emergency room evaluation. One of the primary interventions for managing decreased compliance is external ventricular drainage, which allows for cerebrospinal fluid diversion to improve the intracranial compliance and if it is the case to reduce high intracranial pressure. Spontaneous ventricular catheter displacement is a frequent and risky complication that can reduce treatment efficacy and increase the central nervous system infection rates. The Security And Effectiveness Assessment Of Locking Systems In Ventriculostomy-TBI (SEALS-TBI) clinical study is a prospective, multicenter, observational comparative-effectiveness trial designed to evaluate the impact of ventricular catheter locking systems versus standard ventriculostomy in patients with intracranial compartment syndrome secondary to TBI. The primary objective of the study is to compare functional outcomes and clinical complications associated with both treatment approaches. Data collection will take place from July 2025 to July 2026. The aim of this article is to present the SEALS-TBI study protocol.