Cranial burr hole decompression in the emergency department

Springer, Martin; Baker, F.J.

doi:10.1016/0735-6757(88)90110-6

Cited by 20 publications

(10 citation statements)

References 27 publications

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“…Where this policy was followed in that region, eight of nine patients so treated had favorable outcomes 29 . All available evidence at this time (both of the excluded articles in Table 3 and of the included articles in Table 4, as well as various case reports) support the efficacy of single hole drainage in protecting the patient from brain damage 36,37 …”

Section: Discussionmentioning

confidence: 98%

“…Resources for instruction include the World Health Organization’s free online textbook Surgical Care at the District Hospital, which has a chapter called “Cranial Burr Holes.” 50 The procedure is also reviewed in several articles and emergency medicine procedure books 19–21,26,36,37,44,45,51 . Telemedicine consultation for this procedure has now been reported and will likely help increase the comfort level of EPs by bringing the neurosurgeon’s experience and guidance to the bedside 52 .…”

Section: Discussionmentioning

confidence: 99%

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Local Skull Trephination Before Transfer Is Associated With Favorable Outcomes in Cerebral Herniation from Epidural Hematoma

Nelson

2011

Academic Emergency Medicine

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Objectives: The patient with epidural hematoma and cerebral herniation has a good prognosis with immediate drainage, but a poor prognosis with delay to decompression. Such patients who present to nonneurosurgical hospitals are commonly transferred without drainage to the nearest neurosurgical center. This practice has never been demonstrated to be the safest approach to treating these patients. A significant minority of emergency physicians (EPs) have advised and taught bedside burr hole drainage or skull trephination before transfer for herniating patients. The objective of this study was to assess the effect of nonneurosurgeon drainage on neurologic outcome in patients with cerebral herniation from epidural hematoma.Methods: A structured literature review was performed using EMBASE, the Cochrane Library, and the Emergency Medicine Abstracts database.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Local Skull Trephination Before Transfer Is Associated With Favorable Outcomes in Cerebral Herniation from Epidural Hematoma

Nelson

2011

Academic Emergency Medicine

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“…Mahoney et al [2] reported the usefulness of burr-hole trepanation. While burr-hole surgery is performed in the emergency room to treat patients with a CT diagnosis of brain hematoma [3], additional craniotomy may be necessary because the rate of hematoma evacuation via a single burr hole can be low. On the other hand, advances in endoscopic instrumentation may facilitate the evacuation of intracerebral hematomas [4, 5].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Surgery for Traumatic Acute Subdural Hematoma

Kon¹,

Saitô²,

Uchida³

et al. 2014

Case Rep Neurol

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Traumatic acute subdural hematoma (ASDH) is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4). Computed tomography (CT) demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately.Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

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“…Performing exploratory burr hole in such condition is the outcome of serious discussion in which the neurosurgeon is always on the frontline. Without being abusive, exploratory burr hole is becoming a well justified alternative in underequipped medical centre, but reasons are opposed by Nelson [6] and Rinker et al [7], Smith et al [13], or Springer and Baker [15] for whom the choice of performing exploratory burr hole was due to exceptional circumstances; time of having a scan done or transferring the patients towards a specialized centre was more harmful due to their clinical state. …”

Section: Discussionmentioning

confidence: 99%

The Exploratory Burr Hole: Indication and Results at One Departmental Hospital of Benin

et al. 2013

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Objective. The aim of this study was to describe the indications and results of exploratory burr hole performed at the Departmental Teaching Hospital of Borgou (Benin). Methods. It was a retrospective study performed from January 2008 to February 2011. It concerned patients with a closed traumatic brain injury (TBI) in which an exploratory burr hole was performed. The selection criteria were unilateral mydriasis associated with neurological deficits on the opposite side or the occurrence of a decreased consciousness associated with the appearance of a motor deficit after a lucid interval. Results. Amongst the 74 patients operated, 23 (31%) underwent an exploratory burr hole for which the average age was 24.8 ± 17.3 years. Sex ratio male/female was 3.6. TBI was due to road traffic accident (56.5%), a fall (26.1%), and an assault (17.4%). It was severe (47.8%), moderate (39.1%), and mild (13.1%). Mydriasis was observed in 69.6% of cases as well as neurological deficit in all patients. A lesion was observed in 15 (65.2%) cases. Conclusion. The exploratory burr hole seemed as an old practice, still no longer performed in full practice in Benin, and is a diagnosis and therapeutic approach. Better technical conditions would allow more relevant therapeutic options.

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Cranial burr hole decompression in the emergency department

Cited by 20 publications

References 27 publications

Local Skull Trephination Before Transfer Is Associated With Favorable Outcomes in Cerebral Herniation from Epidural Hematoma

Local Skull Trephination Before Transfer Is Associated With Favorable Outcomes in Cerebral Herniation from Epidural Hematoma

Endoscopic Surgery for Traumatic Acute Subdural Hematoma

The Exploratory Burr Hole: Indication and Results at One Departmental Hospital of Benin

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