Pratiksha Baliga, Neurosurgery Research, Mahatma Gandhi Mission Institute of Health Sciences, Maharashtra, Mumbai, India
Claudia Restrepo-Lugo, Department of Neurosurgery, University of Montreal, Montreal, Canada
William A. Florez-Perdomo, Department of Research, Columbian Clinical Research Group in Neurocritical Care, Cartegena, Colombia
Luis R. Moscote-Salazar, Department of Neurosurgery, AV Healthcare Innovators, LLC, Madison, WI, United States
Tariq Janjua, Director of Neurocritical care & Adjunct Research Coordinator, The National Brain Aneurysm & Tumor Center, Minneapolis, United States
Amit Agrawal, Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Saket Nagar, Bhopal, India
Traumatic brain injury (TBI) is the most important cause of morbidity and mortality around the globe. Recent advances in understanding intracranial pathophysiology and extracranial systemic factors, including the gut–brain axis and mesenteric involvement, suggest a possible but not yet clinically validated role in patient outcomes, although clinical evidence remains limited. The mesentery is a continuous organ composed of connective tissue, vasculature, lymphatics, and immune cells, and has been the centre of attraction in recent years for its influence on systemic inflammation, metabolic regulation, and immune response. This review explores the hypothesized involvement of the mesentery in acute traumatic brain injury, emphasizing its proposed role in neuroinflammatory pathways, gut barrier dysfunction, mesenteric ischemia, and secondary injury mechanisms. In addition to the above, the focus is also on the discussion of the theoretical therapeutic implications of mesenteric modulation in traumatic brain injury management and identifies key research gaps requiring future validation. Given the limited clinical evidence, these findings should be interpreted as hypothesis-generating.
Keywords: Traumatic brain injury. Mesentery. Gut-brain axis. Neuroinflammation. Systemic inflammation.
