Hole-ly Head Wound!: A Guide to Trepanation

Here's a disclaimer: WE DO NOT ADVOCATE TREPANATION IN ANY SHAPE OR FORM! DON'T EVEN THINK OF TRYING IT! THIS IS TO INFORM ONLY!!!

Yesterday was one hell of a day at the Hem. We were experiencing bouts of mass migraines that seemed to be immune to medication of any sort. In those desperate times it seemed the only solution was to bash our skulls in to release the horrid pressure. This wasn't as easy as it seemed, so after quite a bit of debating we eventually decided to put the hammer down and research trepanning instead. It saves us alot of cleaning up!

History: Trepanation has been practiced since ancient times. Trepanned skulls have even been found in prehistoric sites in Europe.

What Happens?:The trepanning procedure involves removing a portion of bone from the skull.

Why?: In ancient times this was believed to rid the skull of evil spirits. Today trepanning is believed to promote the flow of blood to the brain.


The WHO (not the band, the organization) gives a pretty nifty guide to creating burr holes for releasing tension within the skull. REMEMBER KIDS, DON'T TRY THIS AT HOME!

Technique

1. Shave and prepare the skull over the temporal region between the ear and the external limit of the orbit on the side of the suspected compression.

2. Infiltrate the scalp with a local anaesthetic, and make a 3 cm incision through skin and temporal fascia. Separate the temporalis muscle and incise the periosteum. Control bleeding with retractors or electric cautery. Epinephrine in the local anaesthetic will also help control superficial bleeding.

3. Make the burr hole 2 cm above and behind the orbital process of the frontal bone. Using a drill cutter, begin to make a hole through the outer and inner tables. Use little pressure when cutting the inner table to avoid plunging through into the brain. Switch to a conical or cylindrical burr to carefully enlarge the opening

4. If necessary, enlarge the opening further with a ronguer:

•Control bleeding from the anterior branch of the middle meningeal artery using cautery or ligature

•Control venous bleeding with a piece of crushed muscle or a gelatin sponge

•Control bone bleeding with bone wax.

5. Wash out the extradural haematoma with a hand syringe. If an extradural haematoma is not found, look for a subdural haematoma. If present, consider opening the dura to release it or arranging for care at a referral hospital. If no haematoma is found, create a burr hole on the opposite side to exclude contra coup bleeding.

6. Close the scalp in two layers. If there is a dural fluid leak, do not use a drain but close the wound tightly to prevent persistent drainage and a secondary infection.

Other Sites to check out:

- The WHO site
- An Illustrated history of Trepanning
- The Youtube page for the documentary A Hole In The Head which focuses on trepanation.