The Retro-Auricular Incision as a Safe and Effective Alternative for Decompressive Hemicraniectomy. (16th November 2020)

• Record Type: Journal Article
• Authors: Dowlati, Ehsan; Mortazavi, Armin; Keating, Gregory; Mai, Jeffrey C
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_439
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: The decompressive hemicraniectomy (DHC) is used to relieve refractory intracranial hypertension to prevent fatal brainstem compression. Traditionally, the reverse question mark (RQM) incision is utilized, placing the scalp blood supply at risk of injury. METHODS: We performed a retrospective review of all DHCs over a span of 30 months (July 2017-Dec 2019) at our institution and stratified them based on incision: RQM vs. RA. Exclusion criteria included: other incisions, bilateral DHC, penetrating injury to the head, and lack of post-operative imaging. The surface areas of the cranial defect were measured. To normalize measurements and account for difference in cranium size, defect to skull diameter ratios were also measured. Additionally, a review of clinical outcomes, including complications were collected from both cohorts and analyzed. RESULTS: A total of 47 patients in the RQM group and 35 in the RA group. The average surface area for the RA and RQM incisions were 116.9cm 2 and 109.2cm 2 ( P = . 017), respectively. Average defect: skull ratio for RA incision was 0.813 compared to 0.784 for the RQM group ( P = . 019). Of those who survived beyond one-week, the absolute risk for wound and surgical site complications were 7.14% and 17.78% for RA and RQM group, respectively. CONCLUSION: We present a safe and effective alternative incision to the traditional RQM incision used for DHC. The RA incision provides exposure for a larger hemicranium defect and also may lead to less wound complications by preserving major arterial blood supply to the scalp.