Burr hole
Background
- Expanding intracranial hematoma is rapidly fatal and requires early therapeutic intervention. Morbidity/mortality significantly increases if treatment delayed more than 1.9 hours.[1]
Indications
- Epidural or subdural hematoma with midline shift on imaging and unequal pupils on exam.[2]
- GCS <8
- Anticipated extended time to assessment/treatment by neurosurgeon.
Contraindications
- GCS >8
- Neurosurgery available in reasonable timeframe
- Lack of imaging-confirmed epidural or subdural hematoma
- In absence of imaging (e.g. in rural area at facility without CT availability), very high clinical suspicion may be enough.[2]
- e.g. evidence of severe head trauma and unequal pupils, pt presents awake and talking but rapidly deteriorates in setting of head trauma and unequal pupils, etc.
- In absence of imaging (e.g. in rural area at facility without CT availability), very high clinical suspicion may be enough.[2]
Equipment Needed
- Sterile PPE
- Razor
- Chlorhexidine or betadine
- Scalpel
- Small retractors
- Drill (manual or air/electric powered)
- Should have both sharp (penetrator) and dull drill bits or a drill bit with appropriate "clutch" mechanism
- Electrocautery (Bovie), if available
Procedure
Complications
See Also
Epidural hemorrhage Subdural hemorrhage
External Links
References
- ↑ Mendelow AD, Karmi MZ, Paul KS, Fuller GA, Gillingham FJ. Extradural haematoma: effect of delayed treatment. British Medical Journal. 1979;1(6173):1240-1242.
- ↑ 2.0 2.1 Wilson MH, Wise D, Davies G, Lockey D. Emergency burr holes: “How to do it.” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012;20:24. doi:10.1186/1757-7241-20-24.