Emergency craniotomy in a rural Level III trauma center

Area of Science:

• Neurosurgery
• Trauma Surgery
• Emergency Medicine

Background:

• Expanding epidural (EDH) and subdural (SDH) hematomas in closed head injury patients necessitate urgent surgical decompression.
• Access to neurosurgical expertise can be limited in remote or rural trauma centers, posing a challenge for timely intervention.

Purpose of the Study:

• To evaluate the feasibility and outcomes of emergency craniotomies performed by trauma surgeons in a rural setting.
• To assess the effectiveness of neurosurgeon-directed training for trauma surgeons in managing critical head injuries.

Main Methods:

• A Level III trauma center implemented a neurosurgeon-directed training program for five trauma surgeons in emergency craniotomy.
• A retrospective review of patients with closed head injury and Glasgow Coma Scale (GCS) score ≤13 was conducted.
• Patients too unstable for transport underwent burr hole decompression by trained trauma surgeons, with all procedures approved by a consulting neurosurgeon.

Main Results:

• Seven patients with EDH or SDH underwent emergency craniotomy by trauma surgeons due to instability for transport.
• Six of seven survivors (85.7%) had independent function at long-term follow-up, with one experiencing moderate impairment.
• One patient with a GCS of 3 on arrival died.

Conclusions:

• Early craniotomy for expanding EDH and SDH by properly trained trauma surgeons can be life-saving.
• This approach can reduce morbidity in selected cases where timely neurosurgical access is not possible.
• Neurosurgery-directed training empowers trauma surgeons to manage critical neurosurgical emergencies in underserved areas.