APPENDIX C: CLASS VII MEDICAL MATERIEL

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

1. Sterile surgical drapes
2. Sterile gloves
3. Surgical gowns
4. Sterile towels
5. Surgical masks
6. Face shields or eye protection
7. Sterile suction tubing
8. Sterile basins
9. Sterile sponges
10. Antiseptic solution (e.g., Betadine, Chlorhexidine, Chloraprep, Duraprep)

Instruments

1. Craniotomy Set

- Skin hooks

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

1. Electrocautery unit
2. Cautery tips (protected monopolar and bipolar)
3. Hemostatic agents (e.g., Surgicel, Gelfoam (thrombin soaked))
4. Bone wax
5. Hemostatic clips (e.g., Raney clips, hemostats)

Sutures and Closure

1. 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)
2. Skin stapler
3. Needle holders
4. Scalpel with blades: 10 and 15
5. Forceps (Adson and Geralds)
6. Loose sterile dressing: bacitracin ointment, 4x4s, LOOSE Kerlex wrap

Monitoring and Support

1. Portable anesthesia machine
2. Endotracheal tubes
3. Laryngoscope with blades
4. Ventilator
5. Pulse oximeter
6. Blood pressure cuffs
7. Intravenous lines and fluids
8. Intravenous pumps
9. Oxygen supply
10. Suction device

Imaging and Diagnostics

CT Scanner (if available)

Post-Operative Care

1. ICU supplies
2. 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.
3. Intravenous medications (e.g., antibiotics, antiepileptics, analgesics, sedatives)
4. Foley catheters
5. Nasogastric tubes
6. Chest tubes and drainage systems

Documentation

1. Surgical logbook
2. Patient medical record forms
3. Procedure consent forms
4. ICU trifold

For additional information including National Stock Number (NSN), please contact dha.ncr.med-log.list.lpr-cps@health.mil

DISCLAIMER: This is not an exhaustive list. These are items identified to be important for the care of combat casualties.