• Amos O Adeleye, Olusola K Idowu, Reza Ghadirpour, and Corrado Iaccarino.
• Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom. Electronic address: femdoy@yahoo.com.
• World Neurosurg. 2020 Oct 1; 142: 513-519.

BackgroundMajor craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries.MethodsWe describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented.ResultsThe procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4-15). The median trauma to surgery time was 25 hours (range, 13-192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits.ConclusionsCompared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma.Copyright © 2020 Elsevier Inc. All rights reserved.

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