You are a surgeon posted at CHC. A patient of head injury comes to you with rapidly deteriorating sensorium and progressive dilatation and fixation of pupil. Neurosurgeon and CT scan is not available. You decide to make a burr hole to emergently relieve the intracranial pressure. Which of the following sites will you choose?
Ans. c. In the left temporal region if no localizing sign is found Burr hole to emergently relieve the intracranial pressure should be done in the left temporal region if no localizing sign is found, to evaluate and decompress the dominant hemisphere Choice of side for Initial Burr Hole Sta with a temporal burr hole on the side: Ipsilateral to a blown pupil: This will be on the correct side in >85% of epidural hemorrhages and other extra-axial mass lesions. If both pupils are dilated, use the side of the first dilating pupil (If known). If pupils are equal, or it is not known which side dilated first, place on side of obvious external trauma. If no localization clues, place hole on left side (to evaluate and decompress the dominant hemisphere).
In the temporal region contralateral to the side of pupillary dilatation
In the midline if both pupils are equal or it is not known which side dilated first
In the left temporal region if no localizing sign is found
Refer to higher centre if both pupils are equal or it is not known which side dilated first