User:Mr. Ibrahem/Burr hole
| Mr. Ibrahem/Burr hole | |
|---|---|
 Chronic subdural bleed with old burr holes | |
| Other names | Cranial burr hole, trepanation, trephining, trepanning, trephination |
| Specialty | Neurosurgery, emergency medicine |
| Complications | Infection, bleeding[1] |
Burr hole, also known as trepanation, is a procedure in which a hole is made through the skull.[2] This is done to treat epidural or subdural hematomas when midline shift occurs, the Glasgow coma scale is less than 8, and one pupil has enlarged.[1] While most commonly performed by neurosurgery, It may be done by an emergency physician if the former is not available.[3][1]
The person is generally intubated before starting.[1] The location of the bleed is confirm on CT scan and the thickness of the overlying skull is measured.[1] The location is than shaved, sterilized, and injected with lidocaine with epinephrine.[1] An approximately 4 centimeter (1.57" inch) long cut down to the bone is made.[1] This is generally done 2 fingers in-front and 2 fingers above the ear canal.[1] A retractor is than used to keep the skin open while a drill is used to get through the skull.[1] With an epidural hematoma the blood may come out or require gentle suction.[1] In a subdural hematoma, the dura should be lifted with a sharp hook and a X shaped cut made in it.[1]
Antibiotics should be given to prevent infection and the person should receive definitive care by neurosurgery.[1] Trepanation is the oldest known type of surgery with evidence of it being performed throughout history.[4] Anthropologists believe it was originally carried out for spiritual purposes, epilepsy, headaches, head wounds, and mental disorders.[4]
References[edit]
- ^ a b c d e f g h i j k l m n "Unlocking Common ED Procedures – Crackin' the Cranium: A Review of Cranial Burr Hole Decompression". emDOCs.net - Emergency Medicine Education. 9 April 2020. Archived from the original on 28 November 2020. Retrieved 15 March 2021.
- ^ Hobert, L; Binello, E (May 2017). "Trepanation in Ancient China". World neurosurgery. 101: 451–456. doi:10.1016/j.wneu.2016.10.051. PMID 27769950.
- ^ Wilson, MH; Wise, D; Davies, G; Lockey, D (2 April 2012). "Emergency burr holes: "How to do it"". Scandinavian journal of trauma, resuscitation and emergency medicine. 20: 24. doi:10.1186/1757-7241-20-24. PMID 22469190.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ a b Faria, Miguel A. (2013-04-05). "Violence, mental illness, and the brain – A brief history of psychosurgery: Part 1 – From trephination to lobotomy". Surgical Neurology International. 4: 49. doi:10.4103/2152-7806.110146. ISSN 2229-5097. PMC 3640229. PMID 23646259.
{{cite journal}}: CS1 maint: unflagged free DOI (link)