Table 1.

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

Procedure	Indication
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

OUH Oslo University Hospital, ICP intracranial pressure, GCS Glasgow coma score, GCS M GCS motor score, CSF cerebrospinal fluid