Cranial burr holes and emergency craniotomy: review of indications and technique

Burr hole craniotomy for posttraumatic intracranial hematoma is rarely performed since the advent of computerized tomography revolutionized the treatment of these patients. It is still necessary in unique circumstances although, and the clinical urgency may require surgery by a non-neurosurgeon. This occurs rarely in rural or overseas locations in peacetime, but more commonly in combat health support operations where computed tomography and neurosurgeons are not widely available. Recent experiences in the Global War on Terrorism have prompted a detailed review of this procedure. The nonoperative care, localization of intracranial hematoma, and surgical technique are outlined here in detail, and results from the literature are reviewed. This review emphasizes that burr holes should not be performed at random on head-injured patients and should be performed only by general surgeons or other physicians who have undergone formal instruction by experienced neurosurgeons, and every reasonable attempt to contact a neurosurgeon should be made first.