Temporal epidural hematoma surgical technique [Neurosurgery Wiki]

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====== Temporal epidural hematoma surgical technique ======

===== Surgical safety checklist =====

see [[Surgical safety checklist]].

===== Preoperative antibiotic prophylaxis =====

see [[Preoperative antibiotic prophylaxis]].

===== Skin Preparation =====

see [[Skin Preparation]].

===== Positioning =====
The [[supine position]] is used with the patient‘s head rotated for temporal access. Extremes of head rotation can obstruct the jugular venous drainage, and a shoulder roll can combat this problem or lateral positioning ([[park bench position]]).

{{::lateral_positioning.jpg?350|}}


===== Skin incision =====

[[Temporal skin incision]].

{{::temporal_skin_incision..png?250|}}

===== Craniotomy =====

[[Temporal craniotomy]].

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/_qPMtQ9wYN4" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe></html>


===== Technical issues =====

1. [[clot]] removal: lowers ICP and eliminates focal [[mass effect]]. Blood is usually thick coagulum, thus
exposure must provide access to most of clot. Craniotomy permits more complete evacuation of
hematoma than e.g. [[burr hole]]s.

2. [[hemostasis]]:coagulate bleeding soft tissue (dural veins & arteries). Apply [[bone wax]] to intradiploic bleeders (e.g. middle meningeal artery). Also requires large exposure

3. prevent reaccumulation: (some bleeding may recur, and dura is now detached from inner table)
place dural tack-up sutures to edges of craniotomy and use central “tenting” suture.