Emergent craniotomy in rural and regional settings – recommendations from a tertiary neurosurgery unit: surgical technique and future prospects

Abstract

Kenneth G Jamieson described the emergent craniotomy for traumatic brain injuries (TBI) in the rural and regional setting back in 1965 in his book 'A First Notebook Of Head Injury'. Since then, there has been successful use of the technique in peripheral hospitals prior to the safe transfer of patients to metropolitan trauma centres. Although the procedure can be daunting in inexperienced hands, our institution supports ongoing education to continue implementation of trauma craniotomies by non-neurosurgeons if it means another life is potentially saved. Here we describe the surgical technique for an emergent craniotomy and craniectomy. Although the surgical technique has been described elsewhere, we have done so in a simplified 10-step approach with consideration of available resources in the peripheral hospital setting and the added pearls from the experience of a metropolitan neurosurgical unit. We also discuss future prospects for undertaking neurosurgical operations in peripheral hospitals but with intra-operative tele-surgery monitoring and supervision.

Emergent craniotomy in rural and regional settings: recommendations from a tertiary neurosurgery unit: diagnosis and surgical decision‐making

“…If a patient cannot be safely transferred to the nearest neurosurgical unit for surgical intervention, prior preparation for an emergent craniotomy is imperative. The authors strongly recommended that the non‐neurosurgeon becomes familiar with the NSA neurotrauma guideline booklet 7 as well as the rationale for surgery, key anatomical landmarks and surgical technique—this has been described elsewhere 13,20 . The authors also encourage attendance at surgical courses such as the Early Management of Severe Trauma and Definitive Surgical Trauma Care to workshop emergent cranial surgery on cadaveric specimens.…”

“…The authors strongly recommended that the non-neurosurgeon becomes familiar with the NSA neurotrauma guideline booklet 7 as well as the rationale for surgery, key anatomical landmarks and surgical technique-this has been described elsewhere. 13,20 The authors also encourage attendance at surgical courses such as the Early Management of Severe Trauma and Definitive Surgical Trauma Care to workshop emergent cranial surgery on cadaveric specimens. We acknowledge that cranial surgery has pitfalls and nuances that are best appreciated from a more 'hands on' approach.…”

“…Undertaking emergent craniotomies in the rural and regional setting was described by Jamieson in 1965 and has been implemented in the Northern Territory and South Australia with good results 8–10,12 . Under dire circumstances, the ongoing practice of potentially life‐saving emergent cranial surgery in peripheral hospitals is strongly endorsed by the Neurosurgical Society of Australasia (NSA) and our institution 7,13 . However, it is recognized that emergent cranial surgery can be a daunting task in inexperienced hands so ongoing education and support from neurosurgical units is recommended.…”

“…[8][9][10]12 Under dire circumstances, the ongoing practice of potentially life-saving emergent cranial surgery in peripheral hospitals is strongly endorsed by the Neurosurgical Society of Australasia (NSA) and our institution. 7,13 However, it is recognized that emergent cranial surgery can be a daunting task in inexperienced hands so ongoing education and support from neurosurgical units is recommended. It is also recognized that peripheral hospitals may not have attending clinicians with any formal surgical training.…”

‘Burr holes in the bush’: Clinician preparedness for undertaking emergency intracranial haematoma evacuation surgery in rural and regional Queensland

“…3,4 Untenable transfer times have given the need for emergency intracranial haematoma evacuation surgery to be undertaken by non-neurosurgeons outside tertiary centres and good results have been reported in Australia and overseas. [5][6][7][8] Although simplified surgical approaches to intracranial haematoma evacuations for non-neurosurgeons have been recently reviewed, 9,10 there is limited literature exploring the widespread availability of cranial access equipment outside tertiary centres. 11 Queensland is currently serviced by one paediatric and four tertiary centres with resident neurosurgeons, all located in metropolitan areas.…”