13 Mm Midline Shift in Surgery — 72yo Man | Neurosurgery | SMLE Q#1291

A 72-year-old man is brought to the emergency department after a fall down a flight of stairs. He was found on the floor confused and gradually became less responsive over several hours. On arrival, his Glasgow Coma Scale (GCS) score is 7/15 (E2, V2, M3), and he is promptly intubated and resuscitated. Vital signs: T 36.8 °C, BP 160/90 mmHg, HR 88/min, RR 16/min (on ventilator), SpO2 99% on 40% FiO2. Neurologic examination shows right-sided hemiparesis and a dilated, sluggishly reactive left pupil. A non-contrast CT scan of the head reveals an acute left subdural hematoma with a 13 mm midline shift. What is the most appropriate next step in management?