title: Emergency management of epidural haematoma through burr hole evacuation and drainage. A preliminary report.
abstract: BACKGROUND
  Blood clot evacuation through an osteoplastic craniotomy, a procedure requiring neurosurgical expertise and modern medical facilities, is the accepted method for treatment of a pure traumatic epidural haematoma following closed head injury. In certain emergency situations and/or in less sophisticated settings, however, use of this procedure may not be feasible. The present study was undertaken to ascertain whether placement of a burr hole and drainage under negative pressure constituted a rapid, effective and safe approach to manage patients with simple epidural haematomas.
  
  
  METHODS
  Thirteen patients suffering from a traumatic epidural haematoma were treated from January, 1999 to October, 2002. Twelve patients presented with skull fracture but no fracture was depressed. Placement of flexible tubes through a burr hole, followed by continuous suction under negative pressure, enabled aspiration of the clot and drainage of the cavity. In 8 cases, the procedure was performed under local anaesthesia with 2% Xylocaine and with intravenous sedation with propofol as needed. The operative procedure was accomplished within 30 min, and the drainage tube was left in place for 3-5 days. CT scans were performed daily from days 1 to 5.
  
  
  RESULTS
  In 11 of 13 cases, clots were evacuated successfully and patients regained consciousness within 2 hours. Recoveries occurred without significant sequelae. In the remaining 2 cases, the drainage tube was found to be obstructed by a blood clot such that the haematoma was unaffected. A traditional craniotomy was performed within 8-12 hours, and these 2 patients recovered consciousness within the subsequent 6 hours.
  
  
  CONCLUSIONS
  Burr hole evacuation followed by drainage under negative pressure is a safe and effective method for emergency management of a pure traumatic epidural haematoma. To assure safety patients given this procedure should be monitored by daily CT scans. Decompressive craniotomy should be performed if consciousness does not improve within several hours.
authors.affiliation: Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: J T
authors.initials: JT
authors.lastname: Liu
authors.forename: Y S
authors.initials: YS
authors.lastname: Tyan
authors.forename: Y K
authors.initials: YK
authors.lastname: Lee
authors.forename: J T
authors.initials: JT
authors.lastname: Wang
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003392:Cranial Sinuses / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D004388:Dura Mater / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D004824:Epidural Space / Q000473:pathology / Q000601:surgery; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications*; D006407:Hematoma, Epidural, Cranial / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008576:Meningeal Arteries / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D012886:Skull / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D012887:Skull Fractures / Q000150:complications / Q000503:physiopathology; D013396:Suction / Q000295:instrumentation / Q000379:methods / Q000592:standards; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014474:Unconsciousness / Q000209:etiology / Q000503:physiopathology / Q000601:surgery