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A Simple Method for Reconstruction of the Temporalis Muscle Using Contourable Strut Plate after Pterional Craniotomy: Introduction of the Surgical Techniques and Analysis of Its Efficacy.

Park JH, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG - J Cerebrovasc Endovasc Neurosurg (2015)

Bottom Line: Lower incidences of ID of the muscle (p < 0.001), DTL (p < 0.001), and PITF (p = 0.001) were observed in the MC + CSP than in the MC Only group.The incidence of acceptable outcome was markedly higher in the MC + CSP group (p < 0.001).ID was regarded as a causative factor for DTL and PITF (p < 0.001 in both).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea.

ABSTRACT

Objective: Pterional craniotomy (PC) using myocutaneous (MC) flap is a simple and efficient technique; however, due to subsequent inferior displacement (ID) of the temporalis muscle, it can cause postoperative deformities of the muscle such as depression along the inferior margin of the temporal line of the frontal bone (DTL) and muscular protrusion at the inferior portion of the temporal fossa (PITF). Herein, we introduce a simple method for reconstruction of the temporalis muscle using a contourable strut plate (CSP) and evaluate its efficacy.

Materials and methods: Patients at follow-ups between January 2014 and October 2014 after PCs were enrolled in this study. Their postoperative deformities of the temporalis muscle including ID, DTL, and PITF were evaluated. These PC cases using MC flap were classified according to two groups; one with conventional technique without CSP (MC Only) and another with reconstruction of the temporalis muscle using CSP (MC + CSP). Statistical analyses were performed for comparison between the two groups.

Results: Lower incidences of ID of the muscle (p < 0.001), DTL (p < 0.001), and PITF (p = 0.001) were observed in the MC + CSP than in the MC Only group. The incidence of acceptable outcome was markedly higher in the MC + CSP group (p < 0.001). ID was regarded as a causative factor for DTL and PITF (p < 0.001 in both).

Conclusion: Reconstruction of the temporalis muscle using CSP after MC flap is a simple and efficient technique, which provides an outstanding outcome in terms of anatomical restoration of the temporalis muscle.

No MeSH data available.


Related in: MedlinePlus

Three-dimensional computed tomography (CT) scans (A, B) of a patient demonstrate the temporal line of the frontal bone (black arrowheads) and the displaced attachment site of the temporalis muscle (white arrowheads). A photograph (C) of the same patient shows a marked depression along the inferior margin of the temporal line of the frontal bone. The axial CT image (D) of a patient demonstrates a muscular protrusion at the inferior portion of the temporal fossa (black asterisk). Photographs (E, F) of the same patient show that this temporal protrusion (black asterisk) may cause discomfort when wearing glasses (white asterisk). Note the imprint on the skin (black arrow) after taking the glasses off.
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Figure 2: Three-dimensional computed tomography (CT) scans (A, B) of a patient demonstrate the temporal line of the frontal bone (black arrowheads) and the displaced attachment site of the temporalis muscle (white arrowheads). A photograph (C) of the same patient shows a marked depression along the inferior margin of the temporal line of the frontal bone. The axial CT image (D) of a patient demonstrates a muscular protrusion at the inferior portion of the temporal fossa (black asterisk). Photographs (E, F) of the same patient show that this temporal protrusion (black asterisk) may cause discomfort when wearing glasses (white asterisk). Note the imprint on the skin (black arrow) after taking the glasses off.

Mentions: Frontotemporal craniotomy, also known as "pterional craniotomy" (PC), provides an optimal microscopic exposure and a wide open working space for manipulation of intracranial structures, and it has been widely used in the field of neurosurgery for treatment of lesions in the anterior and posterior circulations.9) When Yasargil17) first described standard techniques and procedures for PC in his publication in 1984, subgaleal dissection was used for separation and mobilization of the temporalis muscle. Because subgaleal dissection of the temporalis muscle bears significant risk of injury to the frontal branches of the facial nerve, various surgical techniques have been adopted such as interfascial and subfascial dissection. However, interfascial dissection is somewhat complex and time-consuming, and, because the facial nerve sometimes courses into the interfascial space, it still cannot eliminate the risk of facial nerve injury. Subfascial dissection is also time-consuming, and may result in injury to muscle fibers and intramuscular bleeding. These two techniques require transection of the temporalis muscle to leave a cuff for closure, which causes functional and cosmetic problems by muscle fibrosis and atrophy.1)5)6)11)15)18) To minimize the risk of facial nerve injury and temporalis muscle atrophy, another technique of dissecting the temporalis muscle and skin as one flap, known as myocutaneous (MC) flap, was introduced, and this technique is now commonly used.6) Although it is a simple and quick method, inadequate anatomical restoration of the temporalis muscle can cause cosmetic problems such as depression along the inferior margin of the temporal line of the frontal bone and muscular protrusion at the inferior portion of the temporal fossa due to subsequent inferior displacement, or sliding, of the temporalis muscle, and is eventually exacerbated by unexpected atrophy and fibrosis (Fig. 1, 2).


A Simple Method for Reconstruction of the Temporalis Muscle Using Contourable Strut Plate after Pterional Craniotomy: Introduction of the Surgical Techniques and Analysis of Its Efficacy.

Park JH, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG - J Cerebrovasc Endovasc Neurosurg (2015)

Three-dimensional computed tomography (CT) scans (A, B) of a patient demonstrate the temporal line of the frontal bone (black arrowheads) and the displaced attachment site of the temporalis muscle (white arrowheads). A photograph (C) of the same patient shows a marked depression along the inferior margin of the temporal line of the frontal bone. The axial CT image (D) of a patient demonstrates a muscular protrusion at the inferior portion of the temporal fossa (black asterisk). Photographs (E, F) of the same patient show that this temporal protrusion (black asterisk) may cause discomfort when wearing glasses (white asterisk). Note the imprint on the skin (black arrow) after taking the glasses off.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495087&req=5

Figure 2: Three-dimensional computed tomography (CT) scans (A, B) of a patient demonstrate the temporal line of the frontal bone (black arrowheads) and the displaced attachment site of the temporalis muscle (white arrowheads). A photograph (C) of the same patient shows a marked depression along the inferior margin of the temporal line of the frontal bone. The axial CT image (D) of a patient demonstrates a muscular protrusion at the inferior portion of the temporal fossa (black asterisk). Photographs (E, F) of the same patient show that this temporal protrusion (black asterisk) may cause discomfort when wearing glasses (white asterisk). Note the imprint on the skin (black arrow) after taking the glasses off.
Mentions: Frontotemporal craniotomy, also known as "pterional craniotomy" (PC), provides an optimal microscopic exposure and a wide open working space for manipulation of intracranial structures, and it has been widely used in the field of neurosurgery for treatment of lesions in the anterior and posterior circulations.9) When Yasargil17) first described standard techniques and procedures for PC in his publication in 1984, subgaleal dissection was used for separation and mobilization of the temporalis muscle. Because subgaleal dissection of the temporalis muscle bears significant risk of injury to the frontal branches of the facial nerve, various surgical techniques have been adopted such as interfascial and subfascial dissection. However, interfascial dissection is somewhat complex and time-consuming, and, because the facial nerve sometimes courses into the interfascial space, it still cannot eliminate the risk of facial nerve injury. Subfascial dissection is also time-consuming, and may result in injury to muscle fibers and intramuscular bleeding. These two techniques require transection of the temporalis muscle to leave a cuff for closure, which causes functional and cosmetic problems by muscle fibrosis and atrophy.1)5)6)11)15)18) To minimize the risk of facial nerve injury and temporalis muscle atrophy, another technique of dissecting the temporalis muscle and skin as one flap, known as myocutaneous (MC) flap, was introduced, and this technique is now commonly used.6) Although it is a simple and quick method, inadequate anatomical restoration of the temporalis muscle can cause cosmetic problems such as depression along the inferior margin of the temporal line of the frontal bone and muscular protrusion at the inferior portion of the temporal fossa due to subsequent inferior displacement, or sliding, of the temporalis muscle, and is eventually exacerbated by unexpected atrophy and fibrosis (Fig. 1, 2).

Bottom Line: Lower incidences of ID of the muscle (p < 0.001), DTL (p < 0.001), and PITF (p = 0.001) were observed in the MC + CSP than in the MC Only group.The incidence of acceptable outcome was markedly higher in the MC + CSP group (p < 0.001).ID was regarded as a causative factor for DTL and PITF (p < 0.001 in both).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea.

ABSTRACT

Objective: Pterional craniotomy (PC) using myocutaneous (MC) flap is a simple and efficient technique; however, due to subsequent inferior displacement (ID) of the temporalis muscle, it can cause postoperative deformities of the muscle such as depression along the inferior margin of the temporal line of the frontal bone (DTL) and muscular protrusion at the inferior portion of the temporal fossa (PITF). Herein, we introduce a simple method for reconstruction of the temporalis muscle using a contourable strut plate (CSP) and evaluate its efficacy.

Materials and methods: Patients at follow-ups between January 2014 and October 2014 after PCs were enrolled in this study. Their postoperative deformities of the temporalis muscle including ID, DTL, and PITF were evaluated. These PC cases using MC flap were classified according to two groups; one with conventional technique without CSP (MC Only) and another with reconstruction of the temporalis muscle using CSP (MC + CSP). Statistical analyses were performed for comparison between the two groups.

Results: Lower incidences of ID of the muscle (p < 0.001), DTL (p < 0.001), and PITF (p = 0.001) were observed in the MC + CSP than in the MC Only group. The incidence of acceptable outcome was markedly higher in the MC + CSP group (p < 0.001). ID was regarded as a causative factor for DTL and PITF (p < 0.001 in both).

Conclusion: Reconstruction of the temporalis muscle using CSP after MC flap is a simple and efficient technique, which provides an outstanding outcome in terms of anatomical restoration of the temporalis muscle.

No MeSH data available.


Related in: MedlinePlus