Lever technique - A new surgical technique for evacuation of extra dural haematoma in infants and children below two years

Craniotomy has been accepted as the treatment of choice for the management of epidural haematomas (EDH) in adults and children including infants. Some have also stressed on evacuation of EDH by multiple puncture burr hole or even single burr hole technique. It is also possible to evacuate the acute EDH by lever technique craniotomy, taking the advantage of pliability of skull of infants and children below two years, without disrupting the total bony continuity of craniotomy flap with the remaining skull bone. Two cases were managed in this technique with successful evacuation of EDH in our department. After evacuation of EDH, the patients symptomatically improved and discharged on 3rd day. Among all methods, osteoplastic flap is good as it maintains good vascularity of the flap; free flap is somehow less vascular and chance of infection is more. But, this lever technique might be one of the best technique in maintaining flap vascularity, comesis, better bone healing and again very less chance of infection.