A 22-year-old man is brought following a road traffic accident. CT head shows a biconvex hyperdense collection over the right temporoparietal region with 15 mm midline shift. He has a GCS of 9. The most appropriate next step is:
- A IV mannitol and observe; repeat CT in 4 hours
- B Burr hole drainage under local anaesthesia
- C Emergency craniotomy and evacuation of extradural haematoma ✓
- D Decompressive craniectomy as the primary procedure
Explanation
A biconvex (lenticular) hyperdense collection on CT is pathognomonic of extradural haematoma (EDH), most commonly from middle meningeal artery injury. Indications for emergency surgery include EDH volume >30 mL, thickness >15 mm, midline shift >5 mm, or clinical deterioration. This patient has 15 mm shift and GCS 9 — immediate craniotomy and haematoma evacuation is life-saving and outcomes are excellent if performed before transtentorial herniation. Burr holes are a temporizing measure only when craniotomy facilities are unavailable; decompressive craniectomy is not the primary intervention for EDH.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.