The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature

Ordóñez-Rubiano, Edgar G.; Figueredo, Luisa F.; Gamboa-Oñate, Carlos A.; Kehayov, Ivo; Rengifo-Hipus, Jorge A; Romero-Castillo, Ingrid J; Rodríguez-Medina, Angie P; Patiño-Gómez, Javier G.; Zorro, Óscar

doi:10.25259/sni_59_2022

Cited by 5 publications

(5 citation statements)

References 22 publications

(43 reference statements)

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“…1 ). Overall, there were six studies [ 10 , 12 – 17 ] comprising Level III and one study that was Level IV evidence. On NOS risk of bias assessment, scores ranged from 3 to 8.…”

Section: Resultsmentioning

confidence: 99%

“…For studies comparing the RQM and Kempe incisions, the consensus was that both the Kempe and RQM are safe and effective. According to Ordonez-Rubiano [ 17 ], the RQM and Kempe are both effective techniques with comparable risk for scalp necrosis, infection, and cosmetic complications. As noted by Abecassis, the Kempe incision may allow the performance of a larger decompression than the RQM [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

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Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

Brown,

Gendreau,

Rahmani

et al. 2024

Neurosurg Rev

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Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swelling brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoid hemorrhage—essentially any cause of refractory brain swelling and elevated ICPs. Scalp incisions for opening and closing the soft tissues during DHC are crucial to achieve optimal outcomes by promoting proper wound healing and minimizing surgical site infections (SSIs). Though the reverse question mark (RQM) scalp incision has gained significant traction within neurosurgical practice, alternatives—including the retroauricular (RA) and Kempe incisions—have been proposed. As choice of technique can impact postoperative outcomes and complications, we sought to compare outcomes associated with different scalp incision techniques used during DHC. We queried three databases according to PRISMA guidelines in order to identify studies comparing outcomes between the RQM versus “alternative” scalp incision techniques for DHC. Our primary outcome of interest in the present study was postoperative wound infection rates according to scalp incision type. Secondary outcomes included estimated blood loss (EBL) and operative duration. We identified seven studies eligible for inclusion in the formal meta-analysis. The traditional RQM technique shortened operative times by 36.56 min, on average. Additionally, mean EBL was significantly lower when the RQM scalp incision was used. Postoperatively, there was no significant association between DHC incision type and mean intensive care unit (ICU) length of stay (LOS), nor was there a significant difference in predisposition to developing wound complications or infections between the RQM and retroauricular/Kempe incision cohorts. Superficial temporal artery (STA) preservation and reoperation rates were collected but could not be analyzed due to insufficient number of studies reporting these outcomes. Our meta-analysis suggests that there is no significant difference between scalp incision techniques as they relate to surgical site infection and wound complications. At present, it appears that outcomes following DHC can be improved by ensuring that the bone flap is large enough to enable sufficient cerebral expansion and decompression of the temporal lobe, the latter of which is of particular importance. Although previous studies have suggested that there are several advantages to performing alternative scalp incision techniques during DHC, the present study (which is to our knowledge the first to meta-analyze the literature on outcomes in DHC by scalp incision type) does not support these findings. As such, further investigations in the form of prospective trials with high statistical power are merited.

show abstract

“…1 ). Overall, there were six studies [ 10 , 12 – 17 ] comprising Level III and one study that was Level IV evidence. On NOS risk of bias assessment, scores ranged from 3 to 8.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

Brown,

Gendreau,

Rahmani

et al. 2024

Neurosurg Rev

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show abstract

“…Following title and abstract screen as well as nal application of inclusion/exclusion criteria during full-text review, seven studies remained eligible for nal inclusion (Figure 1). Overall, there were six studies 10,[12][13][14][15][16][17] comprising Level III and one study that was Level IV evidence. On NOS risk of bias assessment, scores ranged from 3 to 8.…”

Section: Study Selection and Levels Of Evidence Of Included Studiesmentioning

confidence: 99%

“…For studies comparing the RQM and Kempe incisions, the consensus was that both the Kempe and RQM are safe and effective. According to Ordonez-Rubiano 17 , the RQM and Kempe are both effective techniques with comparable risk for scalp necrosis, infection, and cosmetic complications. As noted by Abecassis, the Kempe incision may allow the performance of a larger decompression than the RQM.…”

Section: Patient Demographics and Surgical Detailsmentioning

confidence: 99%

Scalp Incision Technique for Decompressive Hemicraniectomy: Comparing the Reverse Question Mark to the Alternative Retroauricular and Kempe Incision Techniques

Brown,

Hartke,

Pacult

et al. 2024

33rd Annual Meeting North American Skull Base Society

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Introduction:Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swollen brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoid hemorrhageessentially any cause of refractory brain swelling and elevated ICPs. Scalp incisions for opening and closing the soft tissues during DHC are crucial to achieve optimal outcomes by promoting proper wound healing and minimizing surgical site infections (SSIs). Though the reverse question mark (RQM) scalp incision has gained signi cant traction within neurosurgical practice, alternatives -including the retroauricular (RA) and Kempe incisions -have been proposed. As choice of technique can impact postoperative outcomes and complications, we sought to compare outcomes associated with different scalp incision techniques used during DHC. MethodsWe queried three databases according to PRISMA guidelines in order to identify studies comparing outcomes between the RQM versus "alternative" scalp incision techniques for DHC. Our primary outcome of interest in the present study was postoperative wound infection rates according to scalp incision type. Secondary outcomes included estimated blood loss (EBL) and operative duration. ResultsWe identi ed seven studies eligible for inclusion in formal meta-analysis. The traditional RQM technique shortened operative times by 36.56 minutes, on average. Additionally, mean EBL was signi cantly lower when the RQM scalp incision was used. Postoperatively, there was no signi cant association between DHC incision type and mean intensive care unit (ICU) length of stay (LOS), nor was there a signi cant difference in predisposition to developing wound complications or infections between the RQM and Retroauricular/Kempe incision cohorts. Super cial temporal artery (STA) preservation and reoperation rates were collected but could not be analyzed due to insu cient number of studies reporting these outcomes. ConclusionOur meta-analysis suggests that there may not be a signi cant difference between scalp incision techniques as they relate to surgical site infection and wound complications. At present, it appears that outcomes following DHC can be improved by ensuring that the bone ap is large enough to enable su cient cerebral expansion and decompression of the temporal fossa, the latter of which is of particular importance. Although previous studies have suggested that there are several advantages to performing alternative scalp incision techniques during DHC, the present study (which is to our knowledge the rst to meta-analyze the literature on outcomes in DHC by scalp incision type) does not support these ndings. As such, further investigation in the form of prospective trials with high statistical power are merited.

show abstract

Section: Study Selection and Levels Of Evidence Of Included Studiesmentioning

confidence: 99%

Scalp Incision Technique for Decompressive Hemicraniectomy: Comparing the Reverse Question Mark to the Alternative Retroauricular and Kempe Incision Techniques

Brown,

Gendreau,

Rahmani

et al. 2023

Preprint

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Introduction: Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swollen brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoid hemorrhage – essentially any cause of refractory brain swelling and elevated ICPs. Scalp incisions for opening and closing the soft tissues during DHC are crucial to achieve optimal outcomes by promoting proper wound healing and minimizing surgical site infections (SSIs). Though the reverse question mark (RQM) scalp incision has gained significant traction within neurosurgical practice, alternatives – including the retroauricular (RA) and Kempe incisions – have been proposed. As choice of technique can impact postoperative outcomes and complications, we sought to compare outcomes associated with different scalp incision techniques used during DHC.Methods We queried three databases according to PRISMA guidelines in order to identify studies comparing outcomes between the RQM versus “alternative” scalp incision techniques for DHC. Our primary outcome of interest in the present study was postoperative wound infection rates according to scalp incision type. Secondary outcomes included estimated blood loss (EBL) and operative duration.Results We identified seven studies eligible for inclusion in formal meta-analysis. The traditional RQM technique shortened operative times by 36.56 minutes, on average. Additionally, mean EBL was significantly lower when the RQM scalp incision was used. Postoperatively, there was no significant association between DHC incision type and mean intensive care unit (ICU) length of stay (LOS), nor was there a significant difference in predisposition to developing wound complications or infections between the RQM and Retroauricular/Kempe incision cohorts. Superficial temporal artery (STA) preservation and reoperation rates were collected but could not be analyzed due to insufficient number of studies reporting these outcomes.Conclusion Our meta-analysis suggests that there may not be a significant difference between scalp incision techniques as they relate to surgical site infection and wound complications. At present, it appears that outcomes following DHC can be improved by ensuring that the bone flap is large enough to enable sufficient cerebral expansion and decompression of the temporal fossa, the latter of which is of particular importance. Although previous studies have suggested that there are several advantages to performing alternative scalp incision techniques during DHC, the present study (which is to our knowledge the first to meta-analyze the literature on outcomes in DHC by scalp incision type) does not support these findings. As such, further investigation in the form of prospective trials with high statistical power are merited.

show abstract

The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature

Cited by 5 publications

References 22 publications

Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

Scalp Incision Technique for Decompressive Hemicraniectomy: Comparing the Reverse Question Mark to the Alternative Retroauricular and Kempe Incision Techniques

Scalp Incision Technique for Decompressive Hemicraniectomy: Comparing the Reverse Question Mark to the Alternative Retroauricular and Kempe Incision Techniques

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