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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

Intraoperative photographs demonstrate the technique for reconstruction of the temporalis muscle using a contourable strut plate (CSP). (A) After fixation of the craniotomy bone using instruments such as mini-plates, titanium clamps, or burr hole covers, keyhole defect is repaired by temporal mesh floating technique (white asterisk). The temporal line of the frontal bone is indicated by black arrowheads. (B) A CSP (black asterisk) is slightly bent into the contour of the temporal line of the frontal bone and fixed to the temporal line using two low profile self-tapping screws. (C) The antero-inferior portion of the temporalis muscle is sutured over the temporal mesh. (D, E) The edge of the temporalis fascia and muscle (white arrowheads) is sutured and fixed to the CSP, which is the site of original attachment.
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Figure 4: Intraoperative photographs demonstrate the technique for reconstruction of the temporalis muscle using a contourable strut plate (CSP). (A) After fixation of the craniotomy bone using instruments such as mini-plates, titanium clamps, or burr hole covers, keyhole defect is repaired by temporal mesh floating technique (white asterisk). The temporal line of the frontal bone is indicated by black arrowheads. (B) A CSP (black asterisk) is slightly bent into the contour of the temporal line of the frontal bone and fixed to the temporal line using two low profile self-tapping screws. (C) The antero-inferior portion of the temporalis muscle is sutured over the temporal mesh. (D, E) The edge of the temporalis fascia and muscle (white arrowheads) is sutured and fixed to the CSP, which is the site of original attachment.

Mentions: After fixation of the craniotomy bone using instruments such as mini-plates, titanium clamps, or burr hole covers, keyhole defect was repaired by temporal mesh floating technique.10) CSP was slightly bent into the contour of the temporal line of the frontal bone, and fixed to the temporal line using two low profile self-tapping screws. The antero-inferior portion of the temporalis muscle was sutured over the temporal mesh. The edge of the temporalis fascia and muscle was sutured again and fixed to the CSP, which is the site of original attachment (Fig. 4).


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)

Intraoperative photographs demonstrate the technique for reconstruction of the temporalis muscle using a contourable strut plate (CSP). (A) After fixation of the craniotomy bone using instruments such as mini-plates, titanium clamps, or burr hole covers, keyhole defect is repaired by temporal mesh floating technique (white asterisk). The temporal line of the frontal bone is indicated by black arrowheads. (B) A CSP (black asterisk) is slightly bent into the contour of the temporal line of the frontal bone and fixed to the temporal line using two low profile self-tapping screws. (C) The antero-inferior portion of the temporalis muscle is sutured over the temporal mesh. (D, E) The edge of the temporalis fascia and muscle (white arrowheads) is sutured and fixed to the CSP, which is the site of original attachment.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Intraoperative photographs demonstrate the technique for reconstruction of the temporalis muscle using a contourable strut plate (CSP). (A) After fixation of the craniotomy bone using instruments such as mini-plates, titanium clamps, or burr hole covers, keyhole defect is repaired by temporal mesh floating technique (white asterisk). The temporal line of the frontal bone is indicated by black arrowheads. (B) A CSP (black asterisk) is slightly bent into the contour of the temporal line of the frontal bone and fixed to the temporal line using two low profile self-tapping screws. (C) The antero-inferior portion of the temporalis muscle is sutured over the temporal mesh. (D, E) The edge of the temporalis fascia and muscle (white arrowheads) is sutured and fixed to the CSP, which is the site of original attachment.
Mentions: After fixation of the craniotomy bone using instruments such as mini-plates, titanium clamps, or burr hole covers, keyhole defect was repaired by temporal mesh floating technique.10) CSP was slightly bent into the contour of the temporal line of the frontal bone, and fixed to the temporal line using two low profile self-tapping screws. The antero-inferior portion of the temporalis muscle was sutured over the temporal mesh. The edge of the temporalis fascia and muscle was sutured again and fixed to the CSP, which is the site of original attachment (Fig. 4).

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