Preservation of the temporal muscle during the frontotemporoparietal approach for decompressive craniectomy: Technical note

• Published in: Acta neurochirurgica Vol. 155; no. 7; pp. 1335 - 1339
• Main Authors: Missori, Paolo, Paolini, Sergio, Ciappetta, Pasqualino, Seferi, Arsen, Domenicucci, Maurizio
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.07.2013; Springer Nature B.V
• Subjects: Brain Injuries - surgery; Decompressive Craniectomy - methods; Dura Mater - surgery; Humans; Interventional Radiology; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Postoperative Complications; Skull - surgery; Surgical Flaps; Surgical Orthopedics; Technical Note - Neurosurgical Techniques; Temporal Muscle - pathology; Temporal Muscle - surgery; Treatment Outcome; Reconstructive surgical procedures; Polyethylene; Dural patch; Decompressive craniectomy; Temporal muscle; Intracranial hypertension
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-013-1695-z

Background In patients undergoing decompressive craniectomy, resection and detachment of the temporal muscle produces esthetic and functional damage, due to atrophy of the frontal portion of the temporal muscle in the temporal fossa. We have performed en-block temporal muscle detachment in decompressive craniectomy patients to avoid esthetic and functional damage to the temporal muscle. Methods Twenty-one patients underwent decompressive craniectomy using a frontotemporoparietal approach. Through a three-leaf clover flap skin incision, the temporal muscle was detached en-block and overturned antero-inferiorly conjoined with the frontal myocutaneous flap. A decompressive craniectomy and duraplasty were performed. A polyethylene sheet was added to prevent adherence of the temporal muscle to the dura mater. Results The decompressive craniectomy was effective in all patients. When subsequent cranioplasty was performed, the temporal muscle was easily repositioned. No complications resulted from the en-block temporal muscle detachment or the use of the polyethylene sheet. In 18 patients eligible for clinical and radiological follow-up, excellent ( n  = 4) or good ( n  = 14) esthetic results were detected. Chewing ability is considered normal by all patients. Conclusion Although it requires that the patient undergo two surgical procedures, en-block detachment of the temporal muscle during decompressive craniectomy allows good esthetic and functional results.