The decision to perform a neurosurgical intervention in an austere location is best made with the telemedicine support of a neurosurgeon.

Telemedicine consult may be obtained from the closest neurosurgeon in the evacuation chain. In addition, worldwide neurosurgery consultation is available at Advanced Virtual Support for Operational Forces (ADVISOR): Synchronous, 24/7 provider to provider consultation service for operational forces (833) 238-7756 or DSN (312) 429-9089

If CT scan is available, obtaining a stat CT head (without contrast) will greatly facilitate the appropriate treatment and intervention.

When a CT scan is not available, there is a high risk that procedures may be performed without correct localization of pathology. It is therefore necessary to make an accurate diagnosis, appropriately resuscitate, and exhaust all medical interventions prior to performing a procedure in this environment. Regardless of whether a CT scan is available, the indications for surgical intervention are clinical.