Neurosurgical intervention is greatly facilitated by obtaining the recommended supplies and equipment. The risk of neurosurgical intervention is higher when proper equipment is not available. Every effort should be made to obtain the necessary supplies and equipment if neurosurgical procedures are within the scope of a surgical team’s mission. If only a Gigli saw and Hudson brace are available to an inexperienced provider, the risk of neurosurgical intervention may outweigh the benefit, and medical management may be preferred.

Recommended resources necessary to support non-neurosurgeons who may have to perform cranial procedures in an austere environment should include all of the following:

  1. Tele-conference capability (video-teleconference capability preferred).
  2. Emergency cranial pack that includes an electric drill with cranial perforator bit and matchstick or cutting ball, a Leksell Rongeur, Penfield instruments, bipolar cautery, Dural substitutes, and hemostatic agents (i.e. gel foam, surgicel, etc.). A Gigli saw and Hudson drill may be included as back up should the electric drill fail during the procedure.
  3. Critical care capabilities.

NOTE: Non-invasive measures of intracranial injury are an emerging technology that may be utilized to improve localization of injury or superficial hematoma.

 

Non-invasive Measurement Resources

1. Quantitative pupillometry: This is a small hand-held device that initiates a miotic pupillary response, records the speed of the response, and supplies a normative pupillary index (NPI).1

  • As intracranial pressure increases, the NPI decreases.
  • Asymmetric injury can result in asymmetric NPI and can aide with determining the hemisphere injured.

2. A handheld infrared scanner is another emerging technology for non-invasive brain imaging that may be considered to localize superficial intracranial hematomas.2

 

 

References

 
  1. Taylor WR, Chen JW, Meltzer H, Gennarelli TA, et al. Quantitative Pupillometry, a new technology: normative data and preliminary observations in patients with acute head injury. Technical note.  J Neurosurg. 2003:98(1);205-13.
  2. Sen AN, Gopinath SP, Robertson CS. Clinical application of near-infrared spectroscopy in patients with traumatic brain injury: a review of the progress of the field. Neurophoton. 2016:3(3); 031409.