EMERGENCY BURR HOLE CRANIOSTOMY AND CRANIOTOMY FOR TRAUMATIC BRAIN INJURY IN AUSTERE ENVIRONMENTS: A PRACTICAL GUIDE FOR NON-NEUROSURGEONS eftikhar.akam@som.umaryland.edu

 

EMERGENCY BURR HOLE CRANIOSTOMY AND CRANIOTOMY FOR TRAUMATIC BRAIN INJURY IN AUSTERE ENVIRONMENTS: A PRACTICAL GUIDE FOR NON-NEUROSURGEONS

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United States

Oral or Poster

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity, particularly in austere environments where neurosurgical expertise is scarce. Emergency burr hole craniostomy and craniotomy are critical interventions for managing epidural and subdural hematomas in patients with deteriorating neurological status, and in austere environments these procedures are performed by non-neurosurgeons in most cases with good outcomes. The lack of formal emergency neurosurgery training for non-neurosurgeons is a global issue that needs to be addressed. In the interim, this presentation provides a detailed, practical guide for non-neurosurgeons to perform these procedures in resource-constrained settings without imaging or electric power. The goal is to empower non-specialist surgeons to act decisively, stabilizing patients and bridging them to definitive care, thereby improving outcomes in settings with limited resources

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Emergency burr hole craniostomy and craniotomy are feasible and effective interventions for non-neurosurgeons in austere environments to manage life-threatening TBIs. By rapidly decompressing epidural and subdural hematomas and transforming open head injuries into closed ones, these procedures stabilize patients for transfer to definitive care. Non-neurosurgeons must master clinical assessment, adhere to sterile techniques, and use manual tools like the Gigli saw and rounded burrs to ensure safety. Training programs and remote consultation are essential to empower general surgeons, trauma surgeons, and emergency physicians to act decisively, reducing mortality and morbidity in resource-constrained settings.