Resident SUNY Upstate Syracuse, New York, United States
Disclosure(s):
Haydn Hoffman, MD: No financial relationships to disclose
Introduction: The retroauricular curvilinear (RA) incision has several theoretical benefits compared to the reverse question mark (RQM) incision for decompressive hemicraniectomy (DHC), but limited data comparing the two exist.
Methods: Consecutive patients who underwent DHC between 2017 – 2021 and survived at least 30 days at a single institution were included. The primary outcome was wound complication within 30 days (30dWC) requiring reoperation. Secondary outcomes included 90-day wound complication (90dWC), estimated blood loss (EBL), operative duration, craniectomy size in anterior-posterior (AP) and vertical dimensions, and distance from the inferior craniectomy margin to the middle cranial fossa (MCF).
Results: A total of 103 patients (33 females, 70 males) with a mean age of 47.2 years were included. There were 25 patients in the RA group and 78 patients in the RQM group. Mean EBL was similar between the two incisions (RA: 309 cc, RQM: 434 cc, p = 0.21) but operative duration was longer in the RQM group (RA: 89.4 min, RQM: 103 min, p = 0.04). The incidence of 30dWC was 0 and 1.3% in the RA and RQM groups, respectively (p > 0.99). The incidence of 90dWC was 4% and 2.6% in the RA and RQM groups, respectively (p > 0.99). After adjusting for confounders, there was no difference in mean AP size (RA: 146 mm, RQM: 149 mm, p = 0.29), vertical size (RA: 118 mm, RQM: 119 mm, p = 0.56), and distance from MCF (RA: 18.6 mm, RQM: 15.6 mm, p = 0.08). After cranioplasty, the incidence of 30dWC (RA: 0, RQM: 1.8%, p > 0.99) and 90dWC (RA: 5.3%, RQM: 3.6%, p > 0.99) were similar.
Conclusion : The RA incision is an alternative to RQM that does not compromise craniectomy size or temporal bone removal but may be associated with slightly shorter operative duration.
