Optimising the approach to STA-MCA bypass surgery and reducing wound complications.
STA-MCA bypass
complex intracranial aneurysm
skin incision
wound healing
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
23 Nov 2023
23 Nov 2023
Historique:
received:
30
10
2023
revised:
15
11
2023
accepted:
16
11
2023
medline:
26
11
2023
pubmed:
26
11
2023
entrez:
25
11
2023
Statut:
aheadofprint
Résumé
The treatment of complex intracranial aneurysms with bypass surgery using two branches of the superficial temporal artery (STA) proves to be an effective surgical option. However, the harvest of these two STA branches, combined with a pterional craniotomy, carries the potential risk of delayed wound healing of the skin flap. This study undertook a retrospective analysis to examine and identify the factors associated with this delayed wound healing. A total of 56 consecutive cases, including both ruptured and unruptured complex intracranial aneurysms, that underwent bypass surgery with two branches of the STA, were analyzed retrospectively. Major delayed wound healing was observed in 6 (10.7%) cases. Univariate analysis demonstrated significant associations with the following factors: rupture (P=0.023), presence of diabetes mellitus (P=0.028), large craniotomy size (P=0.012) and the type of skin incision (P=<0.001). Age (P=0.283), sex (P=0.558), body mass index (P=0.221) and other blood test parameters did not demonstrate any statistical significance. Similarly, the presence of a dominant frontal branch (P=0.515) or a low-positioned frontal branch (P=0.622) did not reveal statistically significant results. In the treatment of complex intracranial aneurysms, where harvesting of the two STA branches is involved with a pterional craniotomy, producing a smaller skin flap (L- or T-shaped incision) is effective in minimizing the risk of delayed wound healing. The process of harvesting the STA and closing the wound demands meticulous care, taking into consideration the normal anatomical structures and the subdermal vascular plexus of the scalp.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
The treatment of complex intracranial aneurysms with bypass surgery using two branches of the superficial temporal artery (STA) proves to be an effective surgical option. However, the harvest of these two STA branches, combined with a pterional craniotomy, carries the potential risk of delayed wound healing of the skin flap. This study undertook a retrospective analysis to examine and identify the factors associated with this delayed wound healing.
METHODS
METHODS
A total of 56 consecutive cases, including both ruptured and unruptured complex intracranial aneurysms, that underwent bypass surgery with two branches of the STA, were analyzed retrospectively.
RESULTS
RESULTS
Major delayed wound healing was observed in 6 (10.7%) cases. Univariate analysis demonstrated significant associations with the following factors: rupture (P=0.023), presence of diabetes mellitus (P=0.028), large craniotomy size (P=0.012) and the type of skin incision (P=<0.001). Age (P=0.283), sex (P=0.558), body mass index (P=0.221) and other blood test parameters did not demonstrate any statistical significance. Similarly, the presence of a dominant frontal branch (P=0.515) or a low-positioned frontal branch (P=0.622) did not reveal statistically significant results.
CONCLUSION
CONCLUSIONS
In the treatment of complex intracranial aneurysms, where harvesting of the two STA branches is involved with a pterional craniotomy, producing a smaller skin flap (L- or T-shaped incision) is effective in minimizing the risk of delayed wound healing. The process of harvesting the STA and closing the wound demands meticulous care, taking into consideration the normal anatomical structures and the subdermal vascular plexus of the scalp.
Identifiants
pubmed: 38006937
pii: S1878-8750(23)01643-1
doi: 10.1016/j.wneu.2023.11.082
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.