Management of severe head injuries during the 24 first hours in the emergency department. Neurosurgical approach

In France, the role of the neurosurgeon in the emergency department depends on local health care policies and geographical constraints. Some departmen ts include a neurosurgical team with a dedicated operating room. In others, a neurosurgeon can be reached by phone, possibly with an image transfer. W hatever the case, it should be possible to remove on site and without delay an intracranial haematoma, which is most often an extradural injury. The m anagement of a haematoma of the posterior fossa or a bleeding dural venous sinus would be difficult for a surgeon not qualified in neurosurgery. The o ptimal situation is the presence of a neurosurgeon in the medical team admi tting patients with a severe head or spine trauma, for assessment of the ne urological status, or interpretation of radiological explorations, insertio n of an intracranial pressure monitoring device. Besides the extradural hae matoma, other injuries such as an acute subdural haematoma, a haematoma ass ociated with a contusion, an acute hydrocephalus, a depressed fracture of t he skull, or a craniocerebral wound, also require an emergency decompressiv e procedure. (C) 2000 Editions scientifiques et medicales Elsevier SAS.