II. Indications
- Acute Subdural Hematoma or Epidural Hematoma with rapid deterioration and signs of acute Herniation
- Significant delay until definitive management by neurosurgery
III. Technique
- Define site of Hematoma on CT Head
- If Hematoma site is not accessible via standard landmarks, discuss alternative sites with neurosurgery
- Landmarks (standard, safest location without venous sinuses)
- Two finger breadths anterior to auditory canal
- Two finger breadths above zygoma (level of zygomatic arch)
- Procedure
- Assistant stabilizes the head position
- Mark, prep and anesthetize scalp region
- Make a vertical incision (3-5 cm long) down to bone
- Incision large enough to expose skull for burr tool application
- Self-retaining scalp retractor to expose periosteum
- Use periosteal elevator to elevate periosteum from skull
- Apply and use Burr tool with care to avoid plunging
- Transition from outer to inner skull table will feel like moving from smooth to rough
- Epidural Hematoma will drain spontaneously after passing through inner skull table
- Additional 3-sided incision flap through dura will be needed in cases of Subdural Hematoma
- Apply sterile dressing
- Alternative (Experimental, case reports only from low resource centers)
- Case report of successful trephination with EZ-IO (Intraosseous Cathether Placement)
- Case report used the same landmarks as Burr Tool (see above)
- Use standard adult EZ-IO (25 mm, blue intraosseous needle) and hubbed the catheter
- No cut-down to skull was performed (EZ-IO inserted directly through skin, as done with standard IO)
- References
IV. Efficacy
- Non-neurosurgeon performed emergency trephination is associated with improved outcomes (when neurosurgery not available)
V. References
- (2021) EM:Rap 21(1): 2-3
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Related Studies
| Concepts | Therapeutic or Preventive Procedure (T061) |
| CPT | 1009081 |
| English | Twist Drill, Burr Hole(s), or Trephine Procedures on the Skull, Meninges, and Brain |
Ontology: Evacuation of subdural hematoma (C0521278)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 148664007, 265259009, 59712006 |
| English | Evac intracrn subdur haematoma, Evac intracrn subdur hematoma, Drainage of subdural haematoma, Drainage of subdural hematoma, Subdural hematoma removal, subdural hematoma drainage, subdural hematoma evacuation, Subdural haematoma removal, Evacuation of intracranial subdural haematoma, Evacuation of intracranial subdural hematoma, Evacuation of subdural haematoma, Evacuation of subdural hematoma, Subdural haematoma evacuation, Subdural hematoma evacuation, Evacuation of subdural hematoma (procedure) |
| Italian | Evacuazione di ematoma sottodurale, Asportazione di ematoma subdurale, Drenaggio di ematoma subdurale, Svuotamento di ematoma subdurale |
| Dutch | evacuatie van subduraal hematoom, drainage van subduraal hematoom, subduraal hematoomverwijdering, verwijdering van subduraal hematoom, subduraal hematoomevacuatie |
| French | Drainage d'un hématome sous-dural, Evacuation d'hématome sous-dural, Retrait d'hématome sous-dural, Ecoulement d'hématome sous-dural, Evacuation d'un hématome sous-dural |
| German | subdurales Haematom Entfernung, Ausraeumung eines subduralen Haematoms, subdurales Haematom Ausraeumung, Entleerung eines subduralen Haematoms |
| Portuguese | Drenagem de hematoma subdural, Extracção de hematoma subdural, Evacuação de hematoma subdural |
| Spanish | Drenaje de hematoma subdural, Vaciado de hematoma subdural, Extracción de hematoma subdural, evacuación de un hematoma subdural (procedimiento), evacuación de un hematoma subdural, Evacuación de hematoma subdural |
| Japanese | 硬膜下血腫ドレナージ, 硬膜下血腫除去, ｺｳﾏｸｶｹｯｼｭﾄﾞﾚﾅｰｼﾞ, ｺｳﾏｸｶｹｯｼｭｼﾞｮｷｮ |
| Czech | Evakuace subdurálního hematomu, Odstranění subdurálního hematomu, Vypuštění subdurálního hematomu, Drenáž subdurálního hematomu |
| Hungarian | Subduralis haematoma drainage, Subduralis haematoma evacuatio |
Ontology: Trephination of cranium and drainage of hematoma from subdural space (C2959382)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 446705006 |
| English | Trephination of cranium and drainage of hematoma from subdural space, Trephination of cranium and drainage of chronic hematoma from subdural space (procedure), Trephination of cranium and drainage of haematoma from subdural space, Trephination of cranium and drainage of chronic haematoma from subdural space, Trephination of cranium and drainage of chronic hematoma from subdural space |
| Spanish | trepanación de cráneo y drenaje de hematoma crónico de espacio subdural (procedimiento), trepanación de cráneo y drenaje de hematoma crónico de espacio subdural |
