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CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(01): 071-082
DOI: 10.1055/s-0040-1709953
Original Article

Analysis of Factors Associated with Temporal Hollowing after Pterional Craniotomy

Thanakorn Thiensri
1   Division of Neurosurgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
,
Akaluk limpoka
1   Division of Neurosurgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
,
Chairat Burusapat
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
› Author Affiliations Financial Disclosure Statement The authors have no financial interest in any of the products or devices mentioned in this article.
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Abstract

Background Temporal hollowing is a common complication after pterional craniotomy. Etiologies of hollowing are still in debate and inconclusive. The objective of this study is to determine the etiology and predictive factors of temporal hollowing after pterional craniotomy.

Methods A retrospective study of patients who underwent pterional craniotomy was conducted. Inclusion criteria included older than 18 years, having undergone unilateral pterional craniotomy, and with no craniofacial anomaly or temporal defect. Volumes of bone, temporalis muscle, and extratemporalis layer were calculated.

Results A total of 51 patients were included. Bone volumes of surgical and nonsurgical sites were 219.12 + 23.02 cm3, and 228.39 + 22.76 cm3, respectively (p = 0.04). Difference of bony volume was 9.10 cm3 (3.99%). Volumes of temporalis muscle in surgical and nonsurgical sites were 12.86 + 3.95 cm3, and 18.10 + 6.08 cm3, respectively (p < 0.005). Difference of muscle volume was 5.08 cm3 (28.32%). Volume of extratemporalis soft tissue in surgical and nonsurgical sites were 11.99 + 5.70 cm3, and 17.31 + 7.76 cm3, respectively (p < 0.005). Difference of soft tissue volume was 5.56 cm3 (31.68%). No statistical significance of the difference of bony, muscle, and soft tissue volumes were found between causes of disease, operative time, and postoperative radiation.

Conclusions Hollowing after pterional craniotomy is an unavoidable result. Bone, temporalis muscle, and soft tissues are combined etiologies. No predictive factors including age, sex, causes, operative time, radiation, and surgical technique are demonstrated. Volume of temporal area reduction was 19.74 cm3. Immediate reconstruction is recommended and volume of reconstruction is calculated from preoperative imaging.

Keywords

etiology - factor - pterional craniotomy - temporal hollowing


Publication History

Article published online:
23 April 2020

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  • References

  • 1 Vaca EE, Purnell CA, Gosain AK, Alghoul MS. Postoperative temporal hollowing: is there a surgical approach that prevents this complication? A systematic review and anatomic illustration. J Plast Reconstr Aesthet Surg 2017; 70 (03) 401-415
    CrossrefPubMedGoogle Scholar
  • 2 de Andrade Júnior FC, de Andrade FC, de Araujo Filho CM, Carcagnolo Filho J. Dysfunction of the temporalis muscle after pterional craniotomy for intracranial aneurysms. Comparative, prospective and randomized study of one flap versus two flaps dieresis. Arq Neuropsiquiatr 1998; 56 (02) 200-205
    CrossrefPubMedGoogle Scholar
  • 3 Kim E, Delashaw Jr JB. Osteoplastic pterional craniotomy revisited. Neurosurgery 2011; 68 (01) (Suppl Operative) 125-129, discussion 129
    CrossrefPubMedGoogle Scholar
  • 4 Park J, Hamm IS. Cortical osteotomy technique for mobilizing the temporal muscle in pterional craniotomies. Technical note. J Neurosurg 2005; 102 (01) 174-178
    Google Scholar
  • 5 Matsumoto K, Akagi K, Abekura M, Ohkawa M, Tasaki O, Tomishima T. Cosmetic and functional reconstruction achieved using a split myofascial bone flap for pterional craniotomy. Technical note. J Neurosurg 2001; 94 (04) 667-670
    Google Scholar
  • 6 Steinbacher DM, Wink J, Bartlett SP. Temporal hollowing following surgical correction of unicoronal synostosis. Plast Reconstr Surg 2011; 128 (01) 231-240
    CrossrefPubMedGoogle Scholar
  • 7 Badie B. Cosmetic reconstruction of temporal defect following pterional [corrected] craniotomy. Surg Neurol 1996; 45 (04) 383-384
    CrossrefPubMedGoogle Scholar
  • 8 Oikawa S, Mizuno M, Muraoka S, Kobayashi S. Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy. Technical note. J Neurosurg 1996; 84 (02) 297-299
    CrossrefPubMedGoogle Scholar
  • 9 Kadri PA, Al-Mefty O. The anatomical basis for surgical preservation of temporal muscle. J Neurosurg 2004; 100 (03) 517-522
    Google Scholar
  • 10 Miyazawa T. Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures. Surg Neurol 1998; 50 (04) 347-351, discussion 351
    CrossrefPubMedGoogle Scholar
  • 11 Spetzler RF, Lee KS. Reconstruction of the temporalis muscle for the pterional craniotomy. Technical note. J Neurosurg 1990; 73 (04) 636-637
    CrossrefPubMedGoogle Scholar
  • 12 Zager EL, DelVecchio DA, Bartlett SP. Temporal muscle microfixation in pterional craniotomies. Technical note. J Neurosurg 1993; 79 (06) 946-947
    CrossrefPubMedGoogle Scholar
  • 13 Brunori A, DiBenedetto A, Chiappetta F. Transosseous reconstruction of temporalis muscle for pterional craniotomy: technical note. Minim Invasive Neurosurg 1997; 40 (01) 22-23
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Jin HB, Chung JH, Kim KS, Kim SH, Choe J, Yang JY. Reconstruction of temporal hollowing using two alloplastic materials simultaneously with titanium mesh and a silicone implant. Arch Aesthetic Plast Surg 2019; 25: 37-41
    CrossrefGoogle Scholar
  • 15 Kim S, Matic DB. The anatomy of temporal hollowing: the superficial temporal fat pad. J Craniofac Surg 2005; 16 (04) 651-654
    CrossrefPubMedGoogle Scholar
  • 16 Lacey M, Antonyshyn O, MacGregor JH. Temporal contour deformity after coronal flap elevation: an anatomical study. J Craniofac Surg 1994; 5 (04) 223-227
    CrossrefPubMedGoogle Scholar
  • 17 Kim YS, Yi HS, Kim HK, Han YS. Effectiveness of temporal augmentation using a calvarial onlay graft during pterional craniotomy. Arch Plast Surg 2016; 43 (02) 204-209
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 McNichols CH, Hatef DA, Cole P, Hollier LH, Thornton JF. Contemporary techniques for the correction of temporal hollowing: augmentation temporoplasty with the classic dermal fat graft. J Craniofac Surg 2012; 23 (03) e234-e238
    CrossrefPubMedGoogle Scholar
  • 19 Rapidis AD, Day TA. The use of temporal polyethylene implant after temporalis myofascial flap transposition: clinical and radiographic results from its use in 21 patients. J Oral Maxillofac Surg 2006; 64 (01) 12-22
    PubMedGoogle Scholar
  • 20 Gosain AK. Hydroxyapatite cement paste cranioplasty for the treatment of temporal hollowing after cranial vault remodeling in a growing child. J Craniofac Surg 1997; 8 (06) 506-511
    CrossrefPubMedGoogle Scholar
  • 21 Burstein FD, Cohen SR, Hudgins R, Boydston W. The use of porous granular hydroxyapatite in secondary orbitocranial reconstruction. Plast Reconstr Surg 1997; 100 (04) 869-874
    CrossrefPubMedGoogle Scholar
  • 22 Cheung LK, Samman N, Tideman H. The use of mouldable acrylic for restoration of the temporalis flap donor site. J Craniomaxillofac Surg 1994; 22 (06) 335-341
    PubMedGoogle Scholar
  • 23 Lacey M, Antonyshyn O. Use of porous high-density polyethylene implants in temporal contour reconstruction. J Craniofac Surg 1993; 4 (02) 74-78
    CrossrefPubMedGoogle Scholar
  • 24 Mericli AF, Gampper TJ. Treatment of postsurgical temporal hollowing with high-density porous polyethylene. J Craniofac Surg 2014; 25 (02) 563-567
    CrossrefPubMedGoogle Scholar