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Yamashiro K, Adachi K, Omi T, Wakako A, Higashiguchi S, Nakahara I, Hayakawa M, Sadato A, Hasegawa M, Hirose Y. Risk of postoperative scalp necrosis in the occipital artery region after posterior cranial fossa surgery. Neurosurg Rev 2023; 46:277. [PMID: 37864617 DOI: 10.1007/s10143-023-02189-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
Ischemia-induced postoperative scalp necrosis in the superficial temporal artery (STA) region is known to occur after STA-middle cerebral artery anastomoses. However, no reports have evaluated the risk of postoperative scalp necrosis in the occipital artery (OA) region. This study examined the surgical procedures that pose a risk for postoperative scalp necrosis in the OA region following posterior cranial fossa surgery. Patients who underwent initial posterior fossa craniotomy at our institution from 2015 to 2022 were included. Clinical information was collected using medical records. Regarding surgical procedures, we evaluated the incision design and whether a supramuscular scalp flap was prepared. The supramuscular scalp flap was defined as a scalp flap dissected from the sternocleidomastoid and/or splenius capitis muscles. A total of 392 patients were included. Postoperative scalp necrosis occurred in 19 patients (4.8%). There were 296 patients with supramuscular scalp flaps, and supramuscular scalp flaps prepared in all 19 patients with postoperative necrosis. Comparing incision designs among patients with supramuscular scalp flap, a hockey stick-shaped scalp incision caused postoperative necrosis in 14 of 73 patients (19.1%), and the odds of postoperative scalp necrosis were higher with the hockey stick shape than with the retro-auricular C shape (adjusted odds ratio: 12.2, 95% confidence interval: 3.86-38.3, p = 0.00002). In all the cases, ischemia was considered to be the cause of postoperative necrosis. The incidence of postoperative necrosis is particularly high when a hockey stick-shaped scalp incision is combined with a supramuscular scalp flap.
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Affiliation(s)
- Kei Yamashiro
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, 1 Gotanda, Harisaki-Cho, Okazaki, Aichi, 4440827, Japan.
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
| | - Kazuhide Adachi
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Tatsuo Omi
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, 1 Gotanda, Harisaki-Cho, Okazaki, Aichi, 4440827, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Akira Wakako
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, 1 Gotanda, Harisaki-Cho, Okazaki, Aichi, 4440827, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Saeko Higashiguchi
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, 1 Gotanda, Harisaki-Cho, Okazaki, Aichi, 4440827, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Motoharu Hayakawa
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, 1 Gotanda, Harisaki-Cho, Okazaki, Aichi, 4440827, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | | | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
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Tsunoda S, Inoue T, Segawa M, Kawashima M, Akabane A, Saito N. Superficial temporal artery lengthening technique to prevent postoperative wound complications in direct revascularization to the anterior cerebral artery for Moyamoya disease. Acta Neurochir (Wien) 2022; 164:1845-1854. [PMID: 35304649 DOI: 10.1007/s00701-022-05180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurocognitive dysfunctions or psychomotor symptoms of Moyamoya disease may improve after direct revascularization to the anterior cerebral artery (ACA). However, long-distance harvest of the frontal branch of the superficial temporal artery (STA) is needed to reach the cortical ACA, frequently resulting in postoperative wound complications. To solve this problem, we devised a novel method (STA lengthening technique). In this study, we compared the STA lengthening technique and the conventional method regarding postoperative wound complications. METHODS Twenty-five patients who underwent STA-ACA direct bypass from December 2016 to October 2021 were retrospectively reviewed, and postoperative wound complications were recorded. Magnetic resonance angiography was performed to evaluate the patency of the bypass to the ACA and postoperative development of collaterals to the skin flap. RESULTS Thirty-eight hemispheres (new method [n = 12] vs. conventional method [n = 26]) were treated. Wound complications occurred in 12 surgeries (46%) of the conventional method, and none (0%) of the new method. The anastomosis with the cortical ACA was patent in all surgeries. Postoperative development of collaterals to the skin flap was confirmed after all surgeries (100%) in the new method, whereas after only five surgeries (20%) in the conventional method. CONCLUSION The STA lengthening technique can enable to preserve the collateral circulation to the skin flap postoperatively, resulting in good wound healing.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan.
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Masafumi Segawa
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Atsuya Akabane
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Kim T, Oh CW, Bang JS, Kim JE, Cho WS. Moyamoya Disease: Treatment and Outcomes. J Stroke 2016; 18:21-30. [PMID: 26846757 PMCID: PMC4747064 DOI: 10.5853/jos.2015.01739] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/17/2016] [Accepted: 01/17/2016] [Indexed: 11/23/2022] Open
Abstract
Although the pathogenesis of moyamoya disease (MMD) has not been fully elucidated, the effectiveness of surgical revascularization in preventing stroke has been addressed by many studies. The main mechanism of surgical revascularization is augmenting the intracranial blood flow using an external carotid system by either direct bypass or pial synangiosis. This can improve resting cerebral blood flow as well as vascular reserve capacity. For direct revascularization, the superficial temporal artery is used as the donor artery in most cases, although the occipital artery may be used in limited cases. Usually, the cortical branch of the middle cerebral artery is selected as the recipient of direct anastomosis. As for indirect revascularization, various techniques using different kinds of connective tissues have been introduced. In some cases, reinforcing the anterior cerebral artery and the posterior cerebral artery territories can be considered. The effectiveness of surgical revascularization for preventing ischemic stroke had been generally accepted by many studies. However, for preventing hemorrhagic stroke, new evidence has been added by a recent randomized controlled trial. The incidence of peri-operative complications such as stroke and hyperperfusion syndrome seems to be high due to the nature of the disease and technical demands for treatment. Preventing and adequately managing these complications are essential for ensuring the benefits of surgery.
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Affiliation(s)
- Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
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Sayama T, Inoue T, Uda K, Fujimoto S, Okada Y. Cerebral Blood Flow after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis. ACTA ACUST UNITED AC 2008. [DOI: 10.7887/jcns.17.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Tooru Inoue
- Department of Neurosurgery, Fuculty of Medicine, Fukuoka University
| | - Ken Uda
- Department of Neurosurgery, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Shigeru Fujimoto
- Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Yasushi Okada
- Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
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