Neurosurgery for EveryoneM A R K W I L S O N

@markhwilson

Extracting the Stone or The Cure of Folly

Hieronymous Bosch 1494

“Master, cut away the stone My name is Lubbert Das”

France 6000 BC 40/120 skulls

!

Peru 1000AD 66/411 skulls

Engraving of trephination from Hieronymus Braunschweig’s Buch

der Cirgia 1497

Dr

Dr John Clarke (American) 1664 18th Century, France

Bart Hughes 1962Children have a higher state of consciousness and since children's skulls are not fully closed one can return to an earlier child like state of consciousness by self trephination

www.holeintheheadmovie.com

Heartbeat in the brain

Amanda Fielding, Countess of Wemyss

Ran for MP for Chelsea 1978

But what about

Neur

otRa

uma

If you’re not dead - you should not die

E X T R A D U R A L M A N A G E M E N T

Tension Pneumothorax in your head

Thanks @karelhabig!

I N D I C AT I O N S

• Brain Injury with CT evidence of Extradural Haematoma

• Midline shift / severe effacement

• Pupil dilatation

• Delay in Neurosurgical availability

B U R R H O L E E VA C U AT I O N

Is a thoracostomy for the head…

• Correct side

• Correct location

• Local anaesthesia

• Incision

• Self retainer

• Drill

• Remove inner table

The

Futu

re

V O L U N T E E R ?

P U P I L S

Fixed

Unreactive

Comatosed

Dilated

F U C D• Recent Met analysis n=68

• EDH

• Mortality 30.9% (CI 15.2-49.3)

• Good Outcome 57% (CI 39.-75)

• SDH

• Mortality 73% (CI = 58-85)

• Good Outcome 5.6% (0.9-13.8)

• Prospective Study Needed

@markhwilson

www.goodsam.co.uk