Editorial

The new year has now started, and with it the 25^th volume of the journal. Firstly therefore best wishes to all the readership for the new year. Many of the policy changes induced by the impact of the world economic recession are now announced and this year will no doubt see us battle with their implementation; in every country the effects are starting to be noticed, and not just the UK. No doubt there will be further comment and material in the journal to come on this issue.

Some things however carry on unchanged. Foremost amongst these is that we still have to deal with neurosurgical conditions, and one of the more important of these is trauma, particularly head injury. As I write this a US congresswoman has been shot in the head sustaining a significant brain injury necessitating an acute decompressive craniectomy. Decompressive craniectomy is a topic of interest to the readership, there being a number of trials, one from the UK regarding the utility of this practice, though admittedly not in the acute phase. Much has been written about this subject, some of it I am glad to report in this very journal – indeed a review of this subject is one of the most read articles in the journal.¹ We will now have a very public anecdote as to the outcome, and whilst wishing the victim well it is of course the functional outcome that is critical here, not simply the binary issue of survival.

I am pleased therefore to bring to your attention a number of papers – a mixture of reviews and original articles – on the topic of head injury in the journal. These deal with many facets of the management and include much more than the purely technical surgical aspects. However I have included these types of articles as I believe neurosurgeons have a clear role in providing leadership in head injury throughout the patient journey but particularly during the intensive care stay. Head injury is topical in the United Kingdom with discussions currently happening around the country regarding the best configuration of services to deliver major trauma care – combining timeliness of treatment with access to appropriate expertise. The result from TARN – that non-surgical cases do better under the supervision of neurosurgeons – is to our credit, and we should continue to provide leadership in this area. There is also a paper on paediatric head injuries – the debate over the proper provision of paediatric services continues.

The remainder of the journal has a usual variety of original articles, cases and reports which as usual I hope are of interest– in fact there is something for nearly every sub-speciality. This follows my own policy for the journal – that there should be readable articles in all areas so that we can be educated in all areas of our colleagues' sub-specialist practice as well as our own. Sub-specialisation for sure has brought many benefits, but carries a risk of insularity that I hope the journal can help mitigate.

Lastly I am happy to note that the journal continues to receive an ever increasing number of submissions – I have to advise prospective authors that the standard required for acceptance of items consequently must rise, and this applies especially to case reports. Happily this means that the next few issues can be guaranteed to be stimulating reading; whilst papers may take some time to appear in the print edition of the journal authors will find their articles on-line much earlier.