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Related Experiment Videos

Emergency twist drill trephination

B D Mahoney, G L Rockswold, E Ruiz

    Neurosurgery
    |May 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

    Twist drill trephination can rapidly diagnose extracerebral hematomas in emergency settings when CT scans are delayed. This procedure aids in identifying treatable hematomas, potentially improving patient outcomes.

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    Area of Science:

    • Neurosurgery
    • Emergency Medicine
    • Trauma Surgery

    Background:

    • Uncal herniation, a critical neurosurgical emergency, often necessitates rapid intervention.
    • Intensive medical therapy may be insufficient for rapidly progressing post-traumatic uncal herniation.
    • Timely diagnosis of extracerebral hematomas is crucial for effective management.

    Observation:

    • Twist drill trephination was performed in 51 cases over 54 months for suspected uncal herniation.
    • The procedure involved temporal bone trephination ipsilateral to a dilated pupil, with dural opening for hematoma evacuation.
    • Diagnostic accuracy for extracerebral hematomas was 82% (42/51 cases).

    Findings:

    • Partial hematoma evacuation via trephination led to pupil size reduction in 6 patients.

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  • Three patients showed marked neurological improvement and recovered functional independence post-trephination.
  • Only 56% (23/41) of patients with herniation profiles had significant extracerebral hematomas, highlighting diagnostic challenges.

    • Implications:

    • Twist drill trephination serves as a valuable diagnostic tool when CT scans are delayed or herniation is rapid.
    • It can help avoid unnecessary craniotomies in patients without significant extracerebral hematomas.
    • The procedure demonstrated no complications in this patient cohort, suggesting a favorable safety profile.