see Surgical safety checklist.

see Preoperative antibiotic prophylaxis.

see Skin Preparation.

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).

Temporal skin incision.

Temporal craniotomy.

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 holes.

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.