Burr holes

[bigbaldguy]

Isn't the term hemicraniotomy generally used in regards to removal of one half of the skull? Seems like a double hemicraniotomy would mean removal of both halfs of the cranium protecting the brain? Wouldn't a large flap just be a craniotomy?

 

[Veneficus]

I'm thinking that the idea of a rural doc deciding to drill a hole into a patient's head is probably a bad idea. As was eluded to earlier, a small burr hole will likely do nothing to relieve ICP as there are other places for brain matter to go (i.e. foramen).

I guess I was just assuming a competent physician doing something the right way.

Also, a burr hole will likely only be useful for an epidural or SDH, not an intracerebral bleed or SAH. Many more rural places I visit don't even have access to CT so the chances of a burr hole being attempted are minimal.

This is true, but since the epidural is an emergent situation, I think it would be much better to attempt to relive it than it would be to sit on it hoping that mannitol will reduce ICP while waiting for transfer. Particularly when transfer times are long or patients are already experience significant clinical features.

To be honest, I think there would be more to be gained from common guidelines that are actually implemented well rather than muddying the waters with Doogie Howser stuff. Focus on low normal PCO2, neuroprotective intrubations, elevated HoB to promote venous drainage and lower PEEP settings with prompt evacuation to a neuro guy..

ideal, yes, but extreme circumstances call for extremem measures, particularly when you are not planning to write off a patient because some guidlines don't work.

There is no need for a physician if all they are going to do is follow some guidlines no matter what.

As an aside, can't say I'd agree with the go large or go home philosophy either, especially with fluid in trauma.....

I am particularly fond of massive transfusion...


Trauma is a surgical disease. Severe presentations must be treated surgically. Attempting "Stabilizing" or medical treatment prior to surgical intervention is just delaying the treatment the patient needs.

The only purposes a non-surgical physician has in major trauma is to wave good-bye to a patient on their way to an OR or attempt surgical intervention themselves.

 

[Veneficus]

Isn't the term hemicraniotomy generally used in regards to removal of one half of the skull? Seems like a double hemicraniotomy would mean removal of both halfs of the cranium protecting the brain? Wouldn't a large flap just be a craniotomy?

It is the removal of 2 flaps, one on each side of the skull. (left and right)