Bedside Craniostomy and Serial Aspiration with an Intraosseous Drill/Needle to Temporize an Acute Epidural Hemorrhage with Mass Effect

Abstract

Background: This report describes a technique for an immediate mechanical intervention using a familiar tool for emergency physicians and trauma surgeons to temporize acute epidural bleeding with mass effect. The Monro-Kellie Doctrine suggests that immediate removal of some blood will reduce intracranial pressure and mitigate some of the deleterious effects until the neurosurgeon can respond.

Case description: A 38-year-old male with active extradural hemorrhage and expanding hemtoma with mass effect and herniation was treated at the bedside with an intraosseous drill to perform craniostomy and allow serial aspirations of continued bleeding.

Conclusions: Bedside craniosotmy with an intraosseous drill can allow for immediate temporizing of a large epidural hemorrhage and be applied by emergency physicians and/or trauma specialists when neurosurgical consultation is delayed. Serial aspirations should be performed when hemorrhage is ongoing and until definitive evacuation is performed.

Keywords: Acute skull fracture; Cerebral perfusion pressure; Intracranial pressure; Intraosseous needle; Transtentorial herniation; Traumatic brain injury; Traumatic epidural hematoma.