The Arabic Question Mark Incision for STA-MCA Bypass Surgery: A Technical Note

Hegazy, Ahmed; Al-Shami, Hieder; Adel Ali, Mohamed Fathy; Ibrahim, Emad; Arundhatai, Biswas; Elkatatny, Amr Mostafa

doi:10.21608/pajn.2021.74593.1019

The Arabic Question Mark Incision for STA-MCA Bypass Surgery: A Technical Note

Document Type : Original Articles

Authors

¹ Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College

² Department of Neurosurgery, Al-Azhar University, Cairo, Egypt

³ Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College, Cairo, Egypt

⁴ Department of Neurosurgery, The National Ribat University, Khartoum, Sudan

⁵ Department of Neurological Surgery, Albert Einstein College of Medicine of Yeshiva University/Montefiore Medical Center, Bronx, NY, USA

10.21608/pajn.2021.74593.1019

Abstract

Background: Skin flap necrosis is one of the known complications of neurosurgical surgeries in general and in low flow bypass surgery specially. We report a technique for using the frontal branch of the STA, while basing flap on the parietal branch along with the posterior auricular and occipital arteries.
Methods: The main trunk of STA is palpated in front of the tragus. The skin is then incised directly over the vessel. The main trunk is then dissected and followed distally to the bifurcation. The incision then continues distally, within hairline and over the frontal branch, till adequate length of usable vessel is dissected (preferably not more than 10 cm.). When this point is reached, the incision is curved backwards 90 degrees and continues parallel to midline. The incision then stops at a line coinciding with the posterior margin of the tragus similar to the Arabic question mark (؟).
Result: The technique is simply based on an inverted question mark incision rather than a linear skin incision or conventional question mark.
Conclusion: The technique described allows using the frontal division of the STA while performing a skin flap based on the parietal branch, posterior auricular and occipital arteries, in order to allow performing a larger craniotomy, without the fear of cutaneous necrosis, while still remaining within the hair line for good cosmetic results. The previous incisions deprives the flap of posterior auricular arteries, occipital artery and parietal division. Our technique allows the flap to be used on the arteries described above.

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