Effects of incision location on specimen quality and complications for temporal artery biopsy

Objectives Giant cell arteritis is a vision and potentially life-threatening condition requiring prompt and accurate diagnosis. The current gold standard of diagnosis is temporal artery biopsy. The purpose of this study is to review the technique of temporal biopsy in regard to incision placement, and to determine specimen quality and the incidence of complications, specifically seventh nerve injury. Methods Retrospective cohort study of 125 consecutive patients (137 biopsies) who underwent temporal artery biopsy. Variables concerning the procedure collected included laterality, incision placement, Doppler ultrasound utilization, length of intraoperative and pathologic specimens, result of the biopsy, motor nerve deficit, brow ptosis, and any intra or postoperative complications. Results The patient population was 73% female and 86% Caucasian. The average age at the time of the biopsy was 73.8 (range = 56-89, SD = 8.7). Doppler localization was used on 45% of patients. The mean intraoperative specimen length was 2.6 cm (range = 1.5-4.1, SD = 0.6) and fixed specimen length was 2.0 cm (range = 0.8-4.0, SD = 0.7). Biopsy results were positive in 18% of cases. There were no patients who displayed seventh nerve injury at one-week follow-up. One patient (0.7%) reported persistent anesthesia and one (0.7%) reported persistent paresthesia at the incision site. There were no other intraoperative or postoperative complications reported. Conclusions Placement of the incision at or posterior to the temporal hairline reduces the risk of seventh nerve injury. The posterior incision placement did not affect the quality of specimens or decrease the yield of biopsy results as compared to other studies. The overall complication rate (3%) was minimal and did not involve any motor nerve injury.