1. Traumatic injury to the brain, spine and nerves

Traumatic brain injury is one of the major causes of death among people under the age of 45 and out of hospitalized traumatic brain injury survivors more than half experience long-term disability due to physical, cognitive or psychological deficits. The gravity of the condition stands in sharp contrast to the scientific evidence on the most optimal care strategies in TBI. The aim of our research group is to describe these care strategies, comparing these thereupon and subsequently enabling fast identification of the most effective interventions.

The UNCH line of research on Chronic SubDural Hematoma (CSDH), proven highly successful, has a focus on basic and clinical research. Researchers of several departments and centres collaborate to investigate existing and new treatments embedded in solid research designs with a strong epidemiological focus. Latest publications have evaluated the two most employed techniques, surgery vs. dexamethasone, the value of radiological parameters and the need for well-defined definitions and outcome parameters. Future research is dedicated to experimental techniques, treatment decision aids, and an upgraded severity score.

The UNCH nerve group is recognized as a leading national tertiary center for the treatment of complex peripheral nerve injuries. Services include complex brachial plexus nerve repair, nerve transplantations, nerve transfers and secondary surgery in both infants and adults. Some patients are seen and treated as emergencies as a result of acute trauma, while others are referred with chronic problems associated with earlier injury. 

Traumatic nerve lesions have a profound impact on daily activities. Brachial plexus injuries are the most severe nerve lesions, resulting in the loss of upper limb function. The lesion usually consists of a closed nerve traction injury anatomically located in the supraclavicular part of the brachial plexus. The magnitude and direction of the forces acting during impact on the brachial plexus elements determine lesion severity and need for surgical repair. Other severe nerve lesions caused by sharp trauma, traction injury or compression may lead to loss of power, loss of sensation and pain in the affected limb or body part. Nerve reconstruction can improve function.

Also patients with cervical spinal cord lesions are treated at our center with reconstructive surgery for arm and hand function. Nerve transfers for spinal cord injury take a nerve connected to the spinal cord above the region of injury and attach it to a nerve below the level of injury to reanimate a crucial muscle function.

Timely diagnosis and treatment is crucial in achieving the best outcome in these trauma patients. Surgery can provide meaningful improvements in patient quality of life and long-term functional independence. At the nerve center, we see all patients with a history of a severe nerve injury or cervical spinal cord injury in a team with neurosurgeons, orthopedic surgeons, rehab physicians, neurophysiologist and therapists for an operative plan that is developed for each patient’s unique circumstances.

Research efforts of the nerve group focusses on diagnostic strategy, timing of nerve surgical intervention, new techniques in nerve and secondary surgery and neuroplasticity in brachial plexus lesions. Also, gene therapy for nerve regeneration is studied together with Verhaagen group of the NIN.

2. Vascular injury e.g. intracerebral haemorrhage and subarachnoid haemorrhage

Our group aims to achieve a better understanding of what happens in the brains of patients who have just had a subarachnoid haemorrhage or intracerebral haemorrhage, which are types of stroke. Subarachnoid haemorrhage (SAH) predominantly affects younger adults. The effects of SAH are truly devastating for the patients and their families. One third of patients don't leave hospital and of those that do, a further third never return to work. A further complication is that some people will develop a second stroke within days to weeks after the first haemorrhage, also called delayed cerebral ischaemia (DCI). At the moment, it is unclear why some patients develop DCI and others do not.

In our studies, we focus on understanding more about the long-term outcome of patients with intracranial haemorrhages. Little is known about the outcome and which treatment strategy will lead to better outcome on the long run. Futhermore, secondary brain damage (DCI) is strongly correlated with poor clinical long-term outcome. In our studies we focus on preventing secondary damage with complement inhibition and vasospasm treatment.

3. Prevention of long-term deficit after acute injury and rehabilitation

Prevention of long-term deficit after acute injury and rehabilitation.