Table 1 OUH treatment protocol - indication for emergency neurosurgical procedures [29]

ICP-monitor

GCS < 9 and abnormal CT

GCS < 9, normal CT and ≥ 2 of following features:

age > 40 years or

systolic BP < 90 mmHg or

GCS Motor (GCS M) < 4 (best side)

GCS < 13 and:

prolonged surgery in other organ systems

expected prolonged ventilator therapy due to other injuries

Evacuation of acute subdural hematoma

GCS < 14 and: hematoma volume > 30 ml

or midline shift > 5 mm or hematoma width > 10 mm

Evacuation of epidural hematoma

GCS < 14 and: hematoma volume > 30 ml or midline shift > 5 mm or hematoma width > 15 mm

Evacuation of cerebral contusion

GCS < 12 and: contusion volume > 20 ml or midline shift > 5 mm

In case of contusion in the eloquent cortex (motor cortex, language area), decompressive craniectomy should be considered instead of evacuation of the contusion

CSF diversion

ICP > 22 mmHg for 10 min

ICP > 25 mmHg for 5 min

Decompressive craniectomy

Persisting ICP > 22 mmHg despite all neuroprotective efforts (circulation, ventilation, sedation, positioning, temperature regulation, osmotherapy, CSF-diversion)

If evacuation of mass lesion alone does not provide ICP control

When CT and clinical presentation are compatible with a meaningful life

Age < 60 years