The posterior question mark incision for decompressive hemicraniectomy

Zheng, Zhixing; Chai, Songshan; Gao, Jin; Cai, Yuankun; Mei, Zhimin; Xiong, Nanxiang

doi:10.1007/s00701-022-05226-6

Cited by 1 publication

(3 citation statements)

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“…But there are other risks suggested to be associate with the altered incision. If the incision is extended below the mastoid process, there is a risk of accidentally opening the mastoid air cells and/or the transverse/sigmoid sinus 12 , 15 . Veldeman et al even described a case during which the external auditory canal was opened 16 .…”

Section: Discussionmentioning

confidence: 99%

“…This might happen, since the universally used standard reversed question-mark incision for DHC starts anterior to the tragus, where the STA runs superficially over the temporal root of the zygoma and is jeopardized during incision 8 , 11 . Injuring the STA during the skin incision predisposes the wound to ischemia and consecutive wound-healing disorders 12 . Therefore, the altered posterior question-mark incision starting behind the ear and posterior of the base of the mastoid process was proposed 13 , 14 .…”

Section: Introductionmentioning

confidence: 99%

“…However, it still remains unclear if this incision allows for the exact same size of the bone flap and for a sufficient exploration and decompression of the temporal base compared to the standard reversed question-mark incision. Further, it has been suggested that there is an increased risk of accidentally opening the mastoid air cells or injuring the transverse and sigmoid sinuses 12 , 15 . This might happen if the skin flap behind the ear is retracted too vigorously and if the craniotomy crosses below the superior nuchal line.…”

Section: Introductionmentioning

confidence: 99%

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Craniectomy size and decompression of the temporal base using the altered posterior question-mark incision for decompressive hemicraniectomy

Früh

Zdunczyk

Wolf

et al. 2023

Sci Rep

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The altered posterior question-mark incision for decompressive hemicraniectomy (DHC) was proposed to reduce the risk of intraoperative injury of the superficial temporal artery (STA) and demonstrated a reduced rate of wound-healing disorders after cranioplasty. However, decompression size during DHC is essential and it remains unclear if the new incision type allows for an equally effective decompression. Therefore, this study evaluated the efficacy of the altered posterior question-mark incision for craniectomy size and decompression of the temporal base and assessed intraoperative complications compared to a modified standard reversed question-mark incision. The authors retrospectively identified 69 patients who underwent DHC from 2019 to 2022. Decompression and preservation of the STA was assessed on postoperative CT scans and CT or MR angiography. Forty-two patients underwent DHC with the standard reversed and 27 patients with the altered posterior question-mark incision. The distance of the margin of the craniectomy to the temporal base was 6.9 mm in the modified standard reversed and 7.2 mm in the altered posterior question-mark group (p = 0.77). There was no difference between the craniectomy sizes of 158.8 mm and 158.2 mm, respectively (p = 0.45), and there was no difference in the rate of accidental opening of the mastoid air cells. In both groups, no transverse/sigmoid sinus was injured. Twenty-four out of 42 patients in the modified standard and 22/27 patients in the altered posterior question-mark group had a postoperative angiography, and the STA was preserved in all cases in both groups. Twelve (29%) and 5 (19%) patients underwent revision due to wound-healing disorders after DHC, respectively (p = 0.34). There was no difference in duration of surgery. Thus, the altered posterior question-mark incision demonstrated technically equivalent and allows for an equally effective craniectomy size and decompression of the temporal base without increasing risks of intraoperative complications. Previously described reduction in wound-healing complications and cranioplasty failures needs to be confirmed in prospective studies to demonstrate the superiority of the altered posterior question-mark incision.

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Section: Discussionmentioning

confidence: 99%