====== 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]]. ===== 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.