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The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature

BACKGROUND: Decompressive craniectomy (DC) is a lifesaving procedure, relieving intracranial hypertension. Conventionally, DCs are performed by a reverse question mark (RQM) incision. However, the use of the L. G. Kempe’s (LGK) incision has increased in the last decade. We aim to describe the surgic...

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Autores principales: Ordóñez-Rubiano, Edgar G., Figueredo, Luisa F., Gamboa-Oñate, Carlos A., Kehayov, Ivo, Rengifo-Hipus, Jorge A., Romero-Castillo, Ingrid J., Rodríguez-Medina, Angie P., Patiño-Gomez, Javier G., Zorro, Oscar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282772/
https://www.ncbi.nlm.nih.gov/pubmed/35855131
http://dx.doi.org/10.25259/SNI_59_2022
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author Ordóñez-Rubiano, Edgar G.
Figueredo, Luisa F.
Gamboa-Oñate, Carlos A.
Kehayov, Ivo
Rengifo-Hipus, Jorge A.
Romero-Castillo, Ingrid J.
Rodríguez-Medina, Angie P.
Patiño-Gomez, Javier G.
Zorro, Oscar
author_facet Ordóñez-Rubiano, Edgar G.
Figueredo, Luisa F.
Gamboa-Oñate, Carlos A.
Kehayov, Ivo
Rengifo-Hipus, Jorge A.
Romero-Castillo, Ingrid J.
Rodríguez-Medina, Angie P.
Patiño-Gomez, Javier G.
Zorro, Oscar
author_sort Ordóñez-Rubiano, Edgar G.
collection PubMed
description BACKGROUND: Decompressive craniectomy (DC) is a lifesaving procedure, relieving intracranial hypertension. Conventionally, DCs are performed by a reverse question mark (RQM) incision. However, the use of the L. G. Kempe’s (LGK) incision has increased in the last decade. We aim to describe the surgical nuances of the LGK and the standard RQM incisions to treat patients with severe traumatic brain injury (TBI), intracranial hemorrhage (ICH), empyema, and malignant ischemic stroke. Furthermore, to describe, surgical limitations, wound healing, and neurological outcomes related to each technique. METHODS: To describe a prospective acquired, case series including patients who underwent a DC using either an RQM or an LGK incision in our institution between 2019 and 2020. RESULTS: A total of 27 patients underwent DC. Of those, ten patients were enrolled. The mean age was 42.1 years (26–71), and 60% were male. Five patients underwent DC using a large RQM incision; three had severe TBI, one ICH, and one ischemic stroke. The other five patients underwent DC using an LGK incision (one ICH, one subdural empyema, and one ischemic stroke). About 50% of patients presented severe headaches associated with vomiting, and six presented altered mental status (drowsy or stuporous). Motor deficits were present in four cases. In patients with ischemic or hemorrhagic stroke, symptoms were directly related to the stroke location. Hospital stays varied between 13 and 22 days. No readmissions were recorded, and no fatal outcome was documented during the follow-up. CONCLUSION: The utility of the LGK incision is comparable with the classic RQM incision to treat acute brain injuries, where an urgent decompression must be performed. Some of these cases include malignant ischemic strokes, ICH, and empyema. No differences were observed between both techniques in terms of prevention of scalp necrosis and general cosmetic outcomes.
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spelling pubmed-92827722022-07-18 The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature Ordóñez-Rubiano, Edgar G. Figueredo, Luisa F. Gamboa-Oñate, Carlos A. Kehayov, Ivo Rengifo-Hipus, Jorge A. Romero-Castillo, Ingrid J. Rodríguez-Medina, Angie P. Patiño-Gomez, Javier G. Zorro, Oscar Surg Neurol Int Original Article BACKGROUND: Decompressive craniectomy (DC) is a lifesaving procedure, relieving intracranial hypertension. Conventionally, DCs are performed by a reverse question mark (RQM) incision. However, the use of the L. G. Kempe’s (LGK) incision has increased in the last decade. We aim to describe the surgical nuances of the LGK and the standard RQM incisions to treat patients with severe traumatic brain injury (TBI), intracranial hemorrhage (ICH), empyema, and malignant ischemic stroke. Furthermore, to describe, surgical limitations, wound healing, and neurological outcomes related to each technique. METHODS: To describe a prospective acquired, case series including patients who underwent a DC using either an RQM or an LGK incision in our institution between 2019 and 2020. RESULTS: A total of 27 patients underwent DC. Of those, ten patients were enrolled. The mean age was 42.1 years (26–71), and 60% were male. Five patients underwent DC using a large RQM incision; three had severe TBI, one ICH, and one ischemic stroke. The other five patients underwent DC using an LGK incision (one ICH, one subdural empyema, and one ischemic stroke). About 50% of patients presented severe headaches associated with vomiting, and six presented altered mental status (drowsy or stuporous). Motor deficits were present in four cases. In patients with ischemic or hemorrhagic stroke, symptoms were directly related to the stroke location. Hospital stays varied between 13 and 22 days. No readmissions were recorded, and no fatal outcome was documented during the follow-up. CONCLUSION: The utility of the LGK incision is comparable with the classic RQM incision to treat acute brain injuries, where an urgent decompression must be performed. Some of these cases include malignant ischemic strokes, ICH, and empyema. No differences were observed between both techniques in terms of prevention of scalp necrosis and general cosmetic outcomes. Scientific Scholar 2022-07-08 /pmc/articles/PMC9282772/ /pubmed/35855131 http://dx.doi.org/10.25259/SNI_59_2022 Text en Copyright: © 2022 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Ordóñez-Rubiano, Edgar G.
Figueredo, Luisa F.
Gamboa-Oñate, Carlos A.
Kehayov, Ivo
Rengifo-Hipus, Jorge A.
Romero-Castillo, Ingrid J.
Rodríguez-Medina, Angie P.
Patiño-Gomez, Javier G.
Zorro, Oscar
The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature
title The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature
title_full The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature
title_fullStr The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature
title_full_unstemmed The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature
title_short The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature
title_sort reverse question mark and l.g. kempe incisions for decompressive craniectomy: a case series and narrative review of the literature
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282772/
https://www.ncbi.nlm.nih.gov/pubmed/35855131
http://dx.doi.org/10.25259/SNI_59_2022
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