To perform emergency life-saving cranial procedures in a deployed setting, non-neurosurgeons need a specific set of medical materiel. Here’s an itemized list for such procedures, derived from the clinical practice guidelines and medical standards:
General Instruments and Supplies
- Sterile surgical drapes
- Sterile gloves
- Surgical gowns
- Sterile towels
- Surgical masks
- Face shields or eye protection
- Sterile suction tubing
- Sterile basins
- Sterile sponges
- Antiseptic solution (e.g., Betadine, Chlorhexidine, Chloraprep, Duraprep)
Instruments
1. Craniotomy Set
a. Hudson brace or pneumatic/electric drill
- Burr hole trephine
- Gigli passer/saw with handles or electric/pneumatic craniotome with side-cutting bit
- Rongeurs (Leksell double action, Kerrisons)
- Periosteal elevators and Penfield Dissectors
- Metzenbaum Scissors
- 15 Blade for dura, 10 Blade for skin
b. Ribbon brain retractors
- Plating system with screws for bone flap fixation
c. Non-suturable dural substitute (if available; surgical/gelfoam/autologous pericranium can also be utilized)
d. Irrigation
e. Subgaleal 7-10 Fr surgical drain to bulb suction
2. Craniectomy Set
- Same as craniotomy set minus the plating system
3. Ventriculostomy Set
- Handheld drill or pneumatic drill
- Burr hole bit
a. Heiss retractor
b. Hemostat (periosteal elevation)
c. 18-g needle to fenestrate dura
- Silastic ventricular catheter with trocar for subcutaneous tunneling
- Sterile collection system for cerebrospinal fluid
- Pressure transducer system for intracranial pressure monitoring (if available)
Hemostasis
- Electrocautery unit
- Cautery tips (protected monopolar and bipolar)
- Hemostatic agents (e.g., Surgicel, Gelfoam (thrombin soaked))
- Bone wax
- Hemostatic clips (e.g., Raney clips, hemostats)
Sutures and Closure
- Suture material: 2-0 Vicryl galea, 2-0 Nylon to secure any drains, 4-0 Neurolon or Silk for dura if needed (not indicated for craniectomy/craniotomy with expansile duraplasty)
- Skin stapler
- Needle holders
- Scalpel with blades: 10 and 15
- Forceps (Adson and Geralds)
- Loose sterile dressing: bacitracin ointment, 4x4s, LOOSE Kerlex wrap
Monitoring and Support
- Portable anesthesia machine
- Endotracheal tubes
- Laryngoscope with blades
- Ventilator
- Pulse oximeter
- Blood pressure cuffs
- Intravenous lines and fluids
- Intravenous pumps
- Oxygen supply
- Suction device
Imaging and Diagnostics
CT Scanner (if available)
Post-Operative Care
- ICU supplies
- ICP Monitoring equipment. If transducer unavailable ICP can be checked manually through the CSF collection system). A level and IV pole are helpful to ensure system drainage level.
- Intravenous medications (e.g., antibiotics, antiepileptics, analgesics, sedatives)
- Foley catheters
- Nasogastric tubes
- Chest tubes and drainage systems
Documentation
- Surgical logbook
- Patient medical record forms
- Procedure consent forms
- ICU trifold
For additional information including National Stock Number (NSN), refer to Logistics Plans & Readiness (sharepoint-mil.us)
DISCLAIMER: This is not an exhaustive list. These are items identified to be important for the care of combat casualties.