Minicraniotomy under local anaesthesia and monitored sedation for the operative treatment of uncomplicated traumatic acute extradural haematoma.

BACKGROUND: Major c raniotomy is currently the de-facto operative treatment for traumatic acute extradural haematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries METHODS: We describe the surgical technique of minicraniotomy under local anaesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group is also presented RESULTS: The procedure has been carried out in 10 consecutive patients (7 males) including an infant aged 4months. The age range was thus 4months to 56years. They suffered varying severity, Glasgow coma score (GCS), of head injury, median GCS 11/15, (range, 4/15-15/15) while median trauma-to-surgery time was 25h (range 13-192). The surgery was successfully completed-haematoma evacuated and haemostasis achieved-in all. Median duration of surgery was 90minutes. The in-hospital outcome was Glasgow outcome scale grade of normal status in 6, moderate deficit in 2, and vegetative state in the patient whose preoperative GCS was 4/15. One other patient, admitting GCS 11/15, died 5 days postoperatively from extracranial causes. The surviving patients have been followed up for a median time of 15 months with no new deficits CONCLUSIONS: Compared to full craniotomy under general anaesthesia, minicraniotomy under local anaesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural haematoma.