Checklist/Procedures For Craniectomy

1. Obtain stat non-contrast head CT (if available).
2. Establish teleconsultation with neurosurgeon. Video consultation is preferred. If unable to communicate with a neurosurgeon, recommend a multi-disciplinary discussion which includes the local command authority prior to proceeding.
3. Make every effort to evacuate the patient to a facility where neurosurgery is available within approximately 5 hours.
4. Assess indications for craniectomy.
5. Assess availability of follow-on care.
6. Ensure that maximal medical/critical care management and resuscitation of the patient’s intracranial condition has occurred. This should include appropriate blood component resuscitation, hypertonic saline, anticonvulsant, sedation, etc. in accordance with the Traumatic Brain Injury Management and Neurosurgery in the Deployed Environment CPG.2
7. Ensure that the surgeon training and the facility resources are adequate.
8. If the above indications are met, then, in consultation with a neurosurgeon (when possible), consider intervention as follows. (Note: Review Emergency War Surgery Manual for further details.4)