The Watering Can Technique for Prevention of Postoperative Epidural Hematoma Recurrence

Abstract

Background: Postoperative epidural hematomas (EDH) are relatively common occurrences following emergent or elective craniotomies. While a number of strategies have been reported for management of traumatic EDH, there is no consensus among surgeons regarding the most effective treatment of postoperative EDH. Objective: We describe a novel surgical technique for treatment of postoperative EDH that has proved useful in the prevention of EDH recurrence. Methods: A technique was developed using multiple linear arrays of dural tenting sutures to prevent EDH recurrence in the postoperative setting. Following removal of the EDH, bleeding points are identified and controlled. Dural tenting sutures are then placed in linear array over the entire exposed dural surface. Absorbable gelatin sponges are then placed between the dural tenting sutures in an alternating fashion. Holes corresponding to the dural sutures are drilled into the bone flap, which is fastened to the surrounding skull. Dural sutures are then secured to the overlying bone. The final appearance of the repair resembles a common gardening watering can (WC), hence, the proposed title of the technique. Results: The WC technique for treatment of postoperative EDH is presented. Intraoperative photographs as well as an artist's rendition of the steps involved in the repair are detailed. Of the more than 20 cases of postoperative EDH repaired using the WC method, zero patients required return to the operating room for recurrence. Conclusions: The WC technique for treatment of postoperative EDH provides a simple, effective strategy that may improve outcomes and limit morbidity relative to conventional methods.