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Risk of postoperative scalp necrosis in the occipital artery region after posterior cranial fossa surgery

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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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Acknowledgements

We would like to thank Chiaki Yamashiro (Department of Dermatology, Kurume University, Kurume, Japan) for supervising the contents of this paper as a dermatologist. We would also like to thank Editage (www. editage.com) for English language editing.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Fujita Health University Okazaki Medical Center, 1 Gotanda, Harisaki-Cho, Okazaki, Aichi, 4440827, Japan

    Kei Yamashiro, Tatsuo Omi, Akira Wakako, Saeko Higashiguchi & Motoharu Hayakawa

  2. Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan

    Kei Yamashiro, Kazuhide Adachi, Tatsuo Omi, Akira Wakako, Saeko Higashiguchi, Motoharu Hayakawa, Akiyo Sadato & Yuichi Hirose

  3. Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, 470-1192, Japan

    Ichiro Nakahara

  4. Tokyo D-Tower Hospital, Tokyo, 135-0061, Japan

    Mitsuhiro Hasegawa

Authors
  1. Kei Yamashiro
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  2. Kazuhide Adachi
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  3. Tatsuo Omi
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  10. Yuichi Hirose
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Contributions

Study conception and design: KY. Data collection: KY, TO, AW, and SH. Data Analysis: KY. Article Writing: KY. Article Revision: all authors.

Corresponding author

Correspondence to Kei Yamashiro.

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Ethical approval and consent to participate

The Ethical Review Board of our institution approved this retrospective study (protocol number: HM22-497). We utilized an opt-out method for participation in this retrospective study. Written informed consent for surgery was obtained from all the patients.

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The authors have no relevant financial or non-financial interests to disclose.

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Yamashiro, K., Adachi, K., Omi, T. et al. Risk of postoperative scalp necrosis in the occipital artery region after posterior cranial fossa surgery. Neurosurg Rev 46, 277 (2023). https://doi.org/10.1007/s10143-023-02189-9

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