Parietal Scalp Necrosis: An Unusual Manifestation of Giant Cell Arteritis

Grunewald, Sonja; Bodendorf, Marc Oliver; Maier, Melanie; Simon, Jan‐Christoph; Paasch, Uwe

doi:10.1159/000163082

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…As such, we agree with Kyung et al, who advocate further study in this area to guide the development of biopsy conventions (10). Until such information is available, it remains that expert clinical judgment must be applied on a case-by-case basis regarding whether to proceed with a STA biopsy and if determined to do so, which side, artery, and length should be biopsied (12). For instance, in patients with a history of rhytidectomy, it may be difficult to localize the parietal branch.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have shown an emerging understanding of GCA as a heterogeneous disease that is both more widespread and more varied in presentation than initially believed (9), with documented cases of GCA where histological inflammation is being confined to the frontal (10,11) or parietal branch (12) while sparing the other or confined to other arteries while sparing the STA entirely (13). For example, Bley et al demonstrated heterogeneity of branch involvement using MRI imaging, a technology which could be valuable in directing biopsyrelated decision-making in the future (13).…”

Section: Discussionmentioning

confidence: 99%

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Biopsy of the Parietal Branch of the Superficial Temporal Artery for the Diagnosis of Giant Cell Arteritis

Elahi¹,

Afshin²,

Zoltan

et al. 2022

Journal of Neuro-Ophthalmology

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Background:Biopsy of the superficial temporal artery (STA) is central to the diagnosis of giant cell arteritis (GCA), but determining the ideal biopsy site along the course of the STA continues to be a challenge. Traditionally, the frontal branch or preauricular region of the STA is biopsied because of their accessibility, but biopsy at these locations can produce visible cosmetic defects and social disruption that can be distressing to patients, as well as increase the likelihood of adverse events such as injury to the facial nerve. The authors describe a surgical technique of biopsy of the parietal branch of the STA to improve the patient's perioperative and postoperative experience.Methods:In this retrospective review, 24 patients with clinical suspicion of GCA who underwent biopsy of the parietal branch of the STA were identified. Patients underwent mapping of the branches of the STA with Doppler ultrasound before the procedure. Biopsy of the parietal branch of the STA was conducted using a CO2 laser.Results:Twenty-four patients underwent biopsy of the parietal branch of the STA. Two patients were diagnosed on histopathology with GCA. All patients tolerated the procedure well and without complications.Conclusion:Application of preoperative Doppler ultrasound mapping, use of a CO2 laser for incisions and hemostasis, and selection of the parietal branch allowed for improved cosmetic outcomes, no associated adverse events, and improved overall patient experience. The authors advocate biopsy of the parietal branch of the superficial temporal artery for the diagnosis of GCA in the absence of contraindications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biopsy of the Parietal Branch of the Superficial Temporal Artery for the Diagnosis of Giant Cell Arteritis

Elahi¹,

Afshin²,

Zoltan

et al. 2022

Journal of Neuro-Ophthalmology

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“…Scalp necrosis as initial manifestation of the disease is rare but is associated with increased mortality and loss of vision. 1,2,[8][9][10] Performing a scalp reconstruction via large skin rotation flaps under high immunosuppressive therapy might show higher complication rates and increase the risk for severe infections. 5,9 Although high dose immunosuppressants during extensive dermatosurgical procedures may seem counterintuitive, in our case the therapy was essential to avoid an exacerbation of the underlying GCA disease, and, in combination with intravenous antibiotic prophylaxis, to enable successful wound healing (Figure 3).…”

Section: Dear Editorsmentioning

confidence: 99%

Reconstruction of an extensive scalp defect under high‐dose immunosuppression

Zarnowski,

Kooybaran,

Simon

et al. 2024

J Deutsche Derma Gesell

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“…It is associated with a high risk of blindness (67 %) and even increased mortality (23 %) . In recent decades, many publications on GCA‐related scalp necrosis have described secondary intention healing as the chosen approach, thus accepting a healing process that took many months or even years . In severe clinical cases associated with pain, early surgical intervention has been favored, usually yielding good results.…”

Section: Introductionmentioning

confidence: 99%