Abstract
BackgroundDecompressive hemicraniectomy (DHC) is a lifesaving procedure which every neurosurgeon should master early on. As indications for the procedure are growing, the number of patients eventually requiring skull reconstruction via cranioplasty also increases. The posterior question mark incision is a straightforward alternative to the classic trauma-flap and can easily be adopted. Some particularities exist one should consider beforehand and are discussed here in detail.MethodsSurgical steps, aids, and pitfalls are comprehensively discussed to prepare surgeons who wish to gain experience with this type of incision.ConclusionDue to the lower complication rate after cranioplasty, the posterior question mark incision has superseded the traditional pre-auricular starting anterior question mark incisions, in our department for the performance of decompressive hemicraniectomies.
Highlights
Decompressive hemicraniectomy (DHC) is a lifesaving procedure which every neurosurgeon should master early on
In a recent analysis of 186 DCH patients, the infectious complications rate after secondary cranioplasty was reduced by 14.4% in patients operated via the posterior incision type [6]
We believe that for the healing of a large avascular bone flap, optimal arterial supply is insufficiently provided after the classical trauma-flap incision
Summary
Decompressive hemicraniectomy (DHC) is a lifesaving procedure which every neurosurgeon should master early on. Transcalvarian supply of the skin via meningeal internal carotid artery (ICA) branches is described, its role remains negligible. The reduced vascular supply after the traditional anterior question mark incision does not contribute to increased complications after primary DHC surgery.
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