Introduction: The outbreak of COVID-19 has significantly impacted emergency neurosurgery practice in Croatia, especially for traumatic brain injury (TBI). Herein, we identify the enduring effects of the COVID-19 pandemic on transforming TBI management. It is an institutional analysis of the COVID-19 pandemic’s impact on TBI treatment, based on lessons learned from Croatian experience.

Methods: During 2020, we examined hospital-admitted TBI patients for eight months dividing the observed time intervals into pre-lockdown, lockdown, and post-lockdown periods. Independent variables like gender, age, and severity of the injury, were analyzed using descriptive statistics. The Mann-Whitney U test, Chisquared test, or Fisher’s exact test were used to compare surgical and non-surgical TBI patients and the cause, multiplicity, and type of injury in correlation to the time intervals observed.

Results: The number of surgical TBI patients, the mean age of admitted patients, and the frequency of isolated, and moderate injuries including chronic subdural hematoma, were significantly decreased during the lockdown and post-lockdown periods, when the trend towards diminishing lethal outcomes was also observed.

Conclusion: The COVID-19 pandemic has intensely transformed the patterns of TBI in Croatia, strongly influencing patients’ selection, management, and outcome, forcing neurosurgical service to quickly readjust to the emerging new condition. The experiences gained during the pandemic present an opportunity to improve organizational structure and patient care as neurosurgical activities resume. Specific protocols for COVID-19-positive and COVID-19-suspected TBI patients should be designed to better adjust neurosurgical capability and capacity and minimize the risk of disease transmission among patients and medical personnel.