Procedure

Skull Trephination

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Skull Trephination, Cranial Trephination, Skull Burr Hole, Subdural Hematoma Evacuation, Epidural Hematoma Evacuation

  • Indications
  1. Acute Subdural Hematoma or Epidural Hematoma with rapid deterioration and signs of acute Herniation
  2. Significant delay until definitive management by neurosurgery
  • Technique
  1. Define site of hematoma on CT Head
    1. If hematoma site is not accessible via standard landmarks, discuss alternative sites with neurosurgery
  2. Landmarks (standard, safest location without venous sinuses)
    1. Two finger breadths anterior to auditory canal
    2. Two finger breadths above zygoma (level of zygomatic arch)
  3. Procedure
    1. Mark, prep and anesthetize scalp region
    2. Make a vertical incision large enough to expose skull for burr tool application
    3. Apply and use Burr tool with care to avoid plunging
  • Efficacy
  1. Non-neurosurgeon performed emergency trephination is associated with improved outcomes (when neurosurgery not available)
    1. Nelson (2011) Acad Emerg Med 18(1): 78-85 [PubMed]
    2. Smith (2010) J Emerg Med 39(3):377-83 [PubMed]