Cranial Burr Holes and Emergency Craniotomy: Review of Indications and Technique

Donovan, Daniel J.; Moquin, Ross R.; Ecklund, James M.

doi:10.7205/milmed.171.1.12

Cited by 18 publications

(12 citation statements)

References 49 publications

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“…Although burr holes are not the preferred surgical intervention for acute epidural hematomas, this technique may still be used in some lower-resource settings like KCMC. 8,12,14 In 2013, KCMC established a prospective TBI registry as part of a quality improvement process. 22 The registry consecutively enrolled all patients presenting to the KCMC Emergency Department for treatment of their acute (< 24 hours) TBI.…”

Section: Study Settingmentioning

confidence: 99%

An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

Elahi

Rocha

Silva

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to determine if patients with traumatic brain injury (TBI) in low- and middle-income countries who receive surgery have better outcomes than patients with TBI who do not receive surgery, and whether this differs with severity of injury.METHODSThe authors generated a series of Kaplan-Meier plots and performed multiple Cox proportional hazard models to assess the relationship between TBI surgery and TBI severity. The TBI severity was categorized using admission Glasgow Coma Scale scores: mild (14, 15), moderate (9–13), or severe (3–8). The authors investigated outcomes from admission to hospital day 14. The outcome considered was the Glasgow Outcome Scale–Extended, categorized as poor outcome (1–4) and good outcome (5–8). The authors used TBI registry data collected from 2013 to 2017 at a regional referral hospital in Tanzania.RESULTSOf the final 2502 patients, 609 (24%) received surgery and 1893 (76%) did not receive surgery. There were significantly fewer road traffic injuries and more violent causes of injury in those receiving surgery. Those receiving surgery were also more likely to receive care in the ICU, to have a poor outcome, to have a moderate or severe TBI, and to stay in the hospital longer. The hazard ratio for patients with TBI who underwent operation versus those who did not was 0.17 (95% CI 0.06–0.49; p < 0.001) in patients with moderate TBI; 0.2 (95% CI 0.06–0.64; p = 0.01) for those with mild TBI, and 0.47 (95% CI 0.24–0.89; p = 0.02) for those with severe TBI.CONCLUSIONSThose who received surgery for their TBI had a lower hazard for poor outcome than those who did not. Surgical intervention was associated with the greatest improvement in outcomes for moderate head injuries, followed by mild and severe injuries. The findings suggest a reprioritization of patients with moderate TBI—a drastic change to the traditional practice within low- and middle-income countries in which the most severely injured patients are prioritized for care.

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Section: Study Settingmentioning

confidence: 99%

An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

Elahi

Rocha

Silva

et al. 2019

Neurosurgical Focus

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“…This training can be supported and updated by specialized military illustrated manuals or other publications. 6,14,15 Nevertheless, this training is often limited to the treatment of some chronic subdural hematomas, open cranial wounds, and/or a few acute extradural hematomas, in conditions in which complete neurosurgical facilities are available. The situation is different in remote areas.…”

Section: Discussionmentioning

confidence: 99%

The French mobile neurosurgical unit

Dulou

Dagain

Delmas

et al. 2010

FOC

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The authors present the French concept of a mobile neurosurgical unit (MNSU) as used to provide specific support to remote military medicosurgical units deployed in Africa, South America, Central Europe, and Afghanistan. From 2001 to 2009, 15 missions were performed, for 16 patients. All but 3 of these missions (those in Kosovo, French Guyana, and Afghanistan) concerned Africa. Eleven patients were French soldiers, 3 were civilians, and 2 were Djiboutian soldiers. The conditions that MNSUs were requested for included craniocerebral wounds (2 cases), closed head trauma (7 cases), spinal trauma (5 cases), and spontaneous intracranial hemorrhage (2 cases). In 5 of the 16 cases, neurosurgical treatment was provided on site. All French soldiers and 2 civilians were evacuated to France. The MNSU can be deployed for timely treatment when some delay in neurosurgical management is acceptable.

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“…There was no associated cervical spine injury. The need for emergent surgical decompression [ 6 ] was determined less than 15 minutes after the initial phone call to the neurosurgeon. Surgical technique was discussed via phone transmission and optimized with a scheme ( Figure 3 ) using Microsoft PowerPoint showing skin incision, bilateral craniotomies, and dural tack up sutures crossing the midline.…”

Section: Case Reportmentioning

confidence: 99%

Severe Vertex Epidural Hematoma in a Child: A Case Report of a Management without Expert Neurosurgical Care

Brévart

Bertani

Aden

et al. 2011

Case Reports in Surgery

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Vertex epidural hematomas (VEDHs) are an uncommon situation and difficulties may be encountered in their diagnosis and management. This is more complicated when the surgical management has to be performed by general surgeons, not specialized in neurosurgery, in a remote location. It was in this context that we were brought to care in charge a 2-year-old boy who required a neurosurgical emergency rescue for a severe VEDH in Djibouti. Through the description of this case, we want to emphasize the value of developing a network of teleconsultation for the benefit of remote and isolated locations and learning basic techniques of emergency neurosurgery.

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Cranial Burr Holes and Emergency Craniotomy: Review of Indications and Technique

Cited by 18 publications

References 49 publications

An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

The French mobile neurosurgical unit

Severe Vertex Epidural Hematoma in a Child: A Case Report of a Management without Expert Neurosurgical Care

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