@entity1 with @entity6075 and expanding epidural (EDH) or subdural ( @entity24881 ) @entity1410 require urgent craniotomy for decompression and control of @entity548 . In remote areas where neurosurgeons are not available, @entity130 surgeons may occasionally need to intervene to avert progressive @entity16 and @entity204 . In 1990, a young @entity1 with rapidly deteriorating neurologic signs underwent emergency burr hole decompression of a combined EDH/ @entity24881 at our hospital, with complete recovery. In anticipation of future need, five surgeons at our rural, American College of Surgeons-verified Level III @entity130 center participated in a neurosurgeon-directed course in emergency craniotomy. Since January 1, 1991, 792 @entity1 have been entered into the @entity130 registry, including 60 with @entity6075 and Glasgow @entity772 Scale (GCS) score of 13 or less. All but seven were transferred to a regional Level II @entity130 center, which is a minimum flight time of 1 hour each way. All @entity1 with EDH (5) and 2 of 14 with @entity24881 were deemed too unstable for transport and underwent burr hole decompression followed by immediate transfer. All craniotomies were approved by the consulting neurosurgeon and were done for computed tomography-confirmed lesions combined with neurologic deterioration as demonstrated by (1) GCS score of 8 or less, (2) lateralizing signs (dilated pupil, @entity1269 ), or (3) development of combined @entity1168 and @entity101 . One @entity1 with a GCS score of 3 on arrival died. Seven survivors (mean follow-up, 3.9 years; range, 1-6.5 years), including the index case, function independently, although one survivor has moderate @entity73 . We conclude that early craniotomy for expanding epidural and @entity3439 by properly trained surgeons may save lives and reduce morbidity in properly selected cases when timely access to a neurosurgeon is not possible.

Emergency craniotomy in a rural Level III XXXX center.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'man'] @entity3439 :: ('MESH:D006408', 'Disease') :: ['subdural hematomas'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhage'] @entity1269 :: ('MESH:D010291', 'Disease') :: ['hemiparesis'] @entity73 :: ('MESH:D003072', 'Disease') :: ['cognitive and motor impairment'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurologic injury'] @entity772 :: ('MESH:D003128', 'Disease') :: ['Coma'] @entity1410 :: ('MESH:D006406', 'Disease') :: ['hematoma'] @entity6075 :: ('MESH:D016489', 'Disease') :: ['closed head injury'] @entity24881 :: ('10993', 'Gene') :: ['SDH'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity1168 :: ('MESH:D001919', 'Disease') :: ['bradycardia'] @entity130 :: ('MESH:D014947', 'Disease') :: ['trauma']
@entity130 :: (MESH:D014947,Disease) :: ['trauma']
