Emergency management of epidural haematoma through burr hole evacuation and drainage. A preliminary report

Abstract

Burr hole evacuation followed by drainage under negative pressure is a safe and effective method for emergency management of a pure traumatic epidural haematoma. To assure safety patients given this procedure should be monitored by daily CT scans. Decompressive craniotomy should be performed if consciousness does not improve within several hours.

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

“…In Taiwan, of 13 patients undergoing trephination by CT guidance, five trephinations (3 patients with anisocoria) were done in the ED after rapid deterioration (16). No patient presented with a GCS higher than 11; it is thus unlikely that they were "talk and deteriorate" patients.…”

Traumatic Coronal Suture Diastasis and Contre-Coup Epidural Hematoma

“…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. Only two other cases satisfied these criteria and they are summarized in the Table with our case for comparison, 12,13 with two further cases involving isolated contrecoup posterior fossa epidural hematoma after forehead impact.…”

Combined Endovascular and Endoscopic Surgery for Acute Epidural Hematoma in a Patient With Poor Health

“…Emergency management of AEDH is possible through burr hole hematoma evacuation. 4) The blood clot is aspirated using a bendable tube inserted through the burr hole until the dura appears clean. One or two drainage tubes are then placed in the remaining cavity and connected to a vacuum chamber with strong negative pressure.…”