4. Engraving of trephination from
Hieronymus Braunschweig’s Buch
der Cirgia 1497
Dr
Dr John Clarke (American) 1664 18th Century, France
5. Bart Hughes 1962
Children have a higher state of consciousness and
since children's skulls are not fully closed one can
return to an earlier child like state of consciousness
by self trephination
22. I N D I C AT I O N S
• Brain Injury with CT evidence of
Extradural Haematoma
• Midline shift / severe effacement
• Pupil dilatation
• Delay in Neurosurgical availability
23. B U R R H O L E
E VA C U AT I O N
Is a thoracostomy for the head…
• Correct side
• Correct location
• Local anaesthesia
• Incision
• Self retainer
• Drill
• Remove inner table
29. P U P I L S
Fixed
Unreactive
Comatosed
Dilated
30. F U C D
• Recent Met analysis n=68
• EDH
• Mortality 30.9% (CI 15.2-49.3)
• Good Outcome 57% (CI 39.-75)
• SDH
• Mortality 73% (CI = 58-85)
• Good Outcome 5.6% (0.9-13.8)
• Prospective Study Needed