Steps in Performing a Lateral Parietal Craniotomy
A. The exact location and size of the skin flap vary, depending on extent of the wound, but must not extend to the midline at the top of the skull.
B. Skin clips are placed for hemostasis, and burr holes elevate the skull bone flap.
C–D. The bone flap is removed, the dura mater is opened to expose and release an epidural hematoma, and bleeding vessels are ligated. In the absence of significant brain swelling, the skull plate is reattached once hemorrhage is controlled and other necessary procedures have been accomplished. With significant brain swelling, the dura is closed, sometimes using dural substitutes, and the bone flap is not replaced at initial operation (decompressive craniotomy).