Korean J Neurotrauma.  2016 Oct;12(2):72-76. 10.13004/kjnt.2016.12.2.72.

A Faster and Wider Skin Incision Technique for Decompressive Craniectomy: n-Shaped Incision for Decompressive Craniectomy

• Yang HS
• Hyun D
• Oh CH
• Shim YS
• Park H
• Kim E

• KMID: 2356776
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.72

Abstract

OBJECTIVE
Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety.
METHODS
In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery.
RESULTS
The decompressed area of craniectomy (389.1 cm² vs. 318.7 cm², p=0.041) and the protruded brain volume (151.8 cm³ vs. 116.2 cm³, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339).
CONCLUSION
DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.

Keyword

Dermatologic surgical procedures; Decompressive craniectomy; Surgical procedures, operative; Surgical flaps

MeSH Terms

Brain
Decompression
Decompressive Craniectomy*
Dermatologic Surgical Procedures
Humans
Methods
Mortality
Neurosurgeons
Skin*
Skull
Surgical Flaps
Surgical Procedures, Operative

Figure

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  FIGURE 1 (A, B) Skin incision variation between Group A (n-shaped incision) and Group B (large question mark incision), including the frontal, parietal, and temporal regions.

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  FIGURE 2 The area of the decompression region (A) and the protruded brain volume (V) protruding out of the skull surface were approximately calculated by the following equation: A (area, cm2)=D * d * π; "D" was the anteroposterior diameter of the bone flap; "d" was the perpendicular diameter to D from the superior craniectomy margin to the inferior margin in centimeters; V (volume, cm3)=1/3 * A * H; "A" is the area of the bone flap; and "H" is the height of the outward of the brain on computed tomography from the level of the center of the bone flap in centimeters.

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  FIGURE 3 Case illustration of skin incision in Group A with n-shape skin incision, which included the frontal, parietal, and temporal regions: (A) acute subdural hematoma before surgery; (B) immediate postoperative status; (C-F) 3d-reconstructed decompressed bone area; (G, H) possible skin problem area where 2 lines were crossed (arrows), but most case were improved after simple dressing.

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  FIGURE 4 Different specific decompressions at the temporal bone area in Group A (A) and Group B (B): it is notable that decompression was more widely achieved in white arrow compared to black arrow.

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