Emergency Department Skull Trephination for Epidural Hematoma in Patients Who Are Awake But Deteriorate Rapidly

Smith, Stephen W.; Clark, Miranda; Nelson, Jody; Heegaard, William G.; Lufkin, Kirk C.; Ruiz, Ernest

doi:10.1016/j.jemermed.2009.04.062

Cited by 17 publications

(22 citation statements)

References 20 publications

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“…However, in certain emergency situations where you are short of time, equipments and qualified neurosurgeons to deal with the situation, the use of craniotomy for evacuation of the blood clot may not be feasible. In such situations, the placement of a burr hole and drainage under negative pressure constitutes a rapid, life saving and safe approach to manage patients with simple EDH (13), or skull trephination can be performed in the emergency room before referring the patient to proper neurosurgical center (22).…”

Section: █ Discussionmentioning

confidence: 99%

Burr hole evacuation of extradural hematoma in mass trauma, a life saving and time saving procedure: our experience in earth quake of oct 8th, 2005.

Aurangzeb

Ahmed²,

Maqbool³

et al. 2012

Turkish Neurosurgery

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The present study was performed in patients with EDH in order to define the clinical outcome of EDH evacuated through a single burr hole. █ MATERIAl and METhODSThis descriptive study was performed in the Department of Neurosurgery, Ayub Teaching Hospital (ATH), Abbottabad, Pakistan from 8 th October to 12 th October 2005, during the earthquake. ATH is 1000-bed hospital with a well-established unit and serving about 7 million population. We had two qualified neurosurgeons at the time of the earthquake. On the first day of the earthquake 18 patients were operated for EDH, followed by 13 patients on the second day and 6 patients on the third day. █ INTRODUCTIONHead injury is a major health problem. It is reported that 1% of all deaths and 15% of deaths occurring between 15 and 24 years are secondary to head injury (12,16). The major cause of preventable deaths in head injuries is a delay in diagnosis and treatment of intracranial hematomas (16,20).Deterioration of conscious level and developing focal neurological signs signify a rapidly growing extradural hematoma (EDH) (16). In these cases, an urgent computed tomography (CT) scan will reveal biconvex hyperdense EDH causing effacement of the ventricle and midline shift. Craniotomy/craniectomy and evacuation of the hematoma is the treatment of choise to save the life of these patients (16). AIM:To observe the outcome of burr hole evacuation of extradural hematoma (EDH) in mass head injury. MATERIAl and METhODS:This study included patients of any age who sustained head injury in the earthquake of October 8, 2005, were diagnosed as EDH on computed tomography (CT) scan and were admitted in the neurosurgery ward over a period of 3 days. All patients were followed by serial CT scans and neurological assessments. RESUlTS:A total of 36 patients were included in this study. There were 25 male and 11 female patients and the age range was from 5 years to 50 years. All cases were the victim of the earthquake. All patients underwent surgery for evacuation of EDH through a single burr hole. One patient required craniotomy for EDH due to neurological deterioration on the second postoperative day, and 1 patient died. CONClUSION:As EDH is potentially fatal lesion, evacuation of EDH through a single burr hole has good outcome with less chances of recurrence and complications in mass head injured patients as seen with earthquakes.

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Section: █ Discussionmentioning

confidence: 99%

Burr hole evacuation of extradural hematoma in mass trauma, a life saving and time saving procedure: our experience in earth quake of oct 8th, 2005.

Aurangzeb

Ahmed²,

Maqbool³

et al. 2012

Turkish Neurosurgery

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“…Our situation differed from that of Smith et al (1). Trephination was performed by a generalist (J.T.).…”

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confidence: 79%

“…Smith et al did not claim this: 2 patients with AEDH with lucid intervals without emergent trephination also had a good outcome (1). However, their study indicated that trephination shortened the time to relieving intracranial pressure by 2 h. In AEDH, when the time to drainage is shorter, the outcome is better (1,3). Our patient had anisocoria and an absent light reflex.…”

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confidence: 98%

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Trephination for Acute Epidural Hematoma Using Stainless Wire on a Remote Island

Tokushige¹,

Matsubara

Tanaka

et al. 2012

The Journal of Emergency Medicine

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“…In the setting of the acutely deteriorating patient, the role of emergent skull trephination remains disputed with regards to both safety and benefit. 9,10 This modality is purported to temporize high intracranial pressure while a patient may be transferred to a neurosurgical centre, but recent investigation has expanded to the application of negative pressure clot evacuation with success in avoidance of craniotomy for 11 of 13 patients in a small series of selected patients by Liu and coworkers. 11 A literature review of isolated supratentorial contre-coup epidural hematomas without a coup lesion showed this pathology to be quite rare.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Coronal Suture Diastasis and Contre-Coup Epidural Hematoma

Shamji

Lesiuk

2010

Can. j. neurol. sci.

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Emergency Department Skull Trephination for Epidural Hematoma in Patients Who Are Awake But Deteriorate Rapidly

Cited by 17 publications

References 20 publications

Burr hole evacuation of extradural hematoma in mass trauma, a life saving and time saving procedure: our experience in earth quake of oct 8th, 2005.

Burr hole evacuation of extradural hematoma in mass trauma, a life saving and time saving procedure: our experience in earth quake of oct 8th, 2005.

Trephination for Acute Epidural Hematoma Using Stainless Wire on a Remote Island

Traumatic Coronal Suture Diastasis and Contre-Coup Epidural Hematoma

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