When Not To Perform Cranial Procedures

- Clinical condition and neurologic status stabilized or improved with aggressive medical management.
- Surgeon and resources are not adequate. See Appendix A (Training) and Appendix B (Resources).
- The patient has a post-resuscitation GCS = 3 with bilateral fixed and dilated pupils. This is non-survivable. Refer to Catastrophic Non-Survivable Brain Injury CPG for supportive care.12
- Imaging evaluation demonstrating catastrophic injury with poor clinical prognosis (consult with neurosurgeon, Example: missile crossing zona fatalis.)13