Decompressive craniectomy incisions: all roads lead to bone

Area of Science:

• Neurosurgery
• Surgical Techniques

Background:

• Decompressive craniectomy and craniotomy are common neurosurgical procedures.
• Scalp incision techniques are critical for patient outcomes, influencing vascular supply, cosmetic results, and complication rates.

Purpose of the Study:

• To review current literature on scalp incisions for large unilateral fronto-temporo-parietal craniotomies and craniectomies.
• To assess the advantages, drawbacks, and complication risks associated with various scalp incision types.

Main Methods:

• A systematic review of publications over the past 50 years concerning scalp incisions for fronto-temporo-parietal craniectomies/craniotomies.
• Analysis of 27 full-text studies adhering to PRISMA guidelines.

Main Results:

• Five primary incision types are discussed: question mark, T-Kempe, retroauricular, N-shaped, and cloverleaf.
• Each incision varies in skull access, vascular supply preservation, cosmetic outcome, and risk of wound complications like dehiscence, necrosis, and infection.

Conclusions:

• The traditional reverse-question mark incision poses risks to scalp vascularity and wound healing.
• Alternative incisions such as T-Kempe, retroauricular, N-shaped, and cloverleaf aim to preserve vascular supply.
• Incision selection requires careful consideration of patient anatomy, vessel status, and desired decompression extent.