Surgery for head injury has a varied role depending on the type of lesion, the imaging findings, the patient's neurological status, and the other associated injuries. Extra-axial hematoma

Surgery is usually indicated for subdural or epidural hematomas 5 mm thick or more with a midline shift of more than 5 mm. In addition, all patients with an intracranial hematoma causing significant mass effect who demonstrate a declining level of consciousness or other focal neurological findings, or who have effacement of basilar cisterns on CT scanning, require craniotomy. A patient with a very thin subdural or epidural hematoma associated with midline shift from cerebral edema out of proportion to the mass of the hematoma may not benefit from surgical intervention.

Current operative management is assisted by rapid CT scanning. However, if CT scanning is not available or will be unduly delayed, emergent exploratory burr holes can be made.

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