II. Indications

  1. Acute Subdural Hematoma or Epidural Hematoma with rapid deterioration and signs of acute Herniation
  2. Significant delay until definitive management by neurosurgery

III. 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

IV. 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]

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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ドレナージ, コウマクカケッシュジョキョ
Czech Evakuace subdurálního hematomu, Odstranění subdurálního hematomu, Vypuštění subdurálního hematomu, Drenáž subdurálního hematomu
Hungarian Subduralis haematoma drainage, Subduralis haematoma evacuatio

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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