Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2016; 43(02): 204-209
DOI: 10.5999/aps.2016.43.2.204
Idea and Innovation

Effectiveness of Temporal Augmentation Using a Calvarial Onlay Graft during Pterional Craniotomy

Yoon Soo Kim
Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
,
Hyung Suk Yi
Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
,
Han Kyu Kim
Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea
,
Yea Sik Han
Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

Temporal hollowing occurs to varying degrees after pterional craniotomy. The most common cause of temporal hollowing is a bony defect of the pterional and temporal regions due to the resection of the sphenoid ridge and temporal squama for adequate exposure without overhang. The augmentation of such bony defects is important in preventing craniofacial deformities and postoperative hollowness. Temporal cranioplasty has been performed using a range of materials, such as acrylics, porous polyethylene, bone cement, titanium, muscle flaps, and prosthetic dermis. These methods are limited by the risk of damage to adjacent tissue and infection, a prolonged preparation phase, the possibility of reabsorption, and cost inefficiency. We have developed a method of temporal augmentation using a calvarial onlay graft as a single-stage neurosurgical reconstructive operation in patients requiring craniotomy. In this report, we describe the surgical details and review our institutional outcomes. The patients were divided into pterional craniotomy and onlay graft groups. Clinical temporal hollowing was assessed using a visual analog scale (VAS). Temporal soft tissue thickness was measured on preoperative and postoperative computed tomography (CT) studies. Both the VAS and CT-based assessments were compared between the groups. Our review indicated that the use of an onlay graft was associated with a lower VAS score and left-right discrepancy in the temporal contour than were observed in patients undergoing pterional craniotomy without an onlay graft.

Keywords

Craniotomy - Bone transplantation - Temporal bone


Publication History

Received: 19 August 2015

Accepted: 04 March 2016

Article published online:
20 April 2022

© 2016. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Choudhry OJ, Christiano LD, Arnaout O. et al. Reconstruction of pterional defects after frontotemporal and orbitozygomatic craniotomy using Medpor Titan implant: cosmetic results in 98 patients. Clin Neurol Neurosurg 2013; 115: 1716-1720
    CrossrefPubMedGoogle Scholar
  • 2 Matsumoto K, Akagi K, Abekura M. et al. Cosmetic and functional reconstruction achieved using a split myofascial bone flap for pterional craniotomy: technical note. J Neurosurg 2001; 94: 667-670
    CrossrefPubMedGoogle Scholar
  • 3 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: 12-22
    PubMedGoogle Scholar
  • 4 Badie B. Cosmetic reconstruction of temporal defect following pterional [corrected] craniotomy. Surg Neurol 1996; 45: 383-384
    CrossrefPubMedGoogle Scholar
  • 5 Kadri PA, Al-Mefty O. The anatomical basis for surgical preservation of temporal muscle. J Neurosurg 2004; 100: 517-522
    CrossrefPubMedGoogle Scholar
  • 6 Oikawa S, Mizuno M, Muraoka S. et al. Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy: technical note. J Neurosurg 1996; 84: 297-299
    CrossrefPubMedGoogle Scholar
  • 7 Spetzler RF, Lee KS. Reconstruction of the temporalis muscle for the pterional craniotomy: technical note. J Neurosurg 1990; 73: 636-637
    CrossrefPubMedGoogle Scholar
  • 8 Appell HJ, Gloser S, Duarte JA. et al. Skeletal muscle damage during tourniquet-induced ischaemia. The initial step towards atrophy after orthopaedic surgery?. Eur J Appl Physiol Occup Physiol 1993; 67: 342-347
    CrossrefPubMedGoogle Scholar
  • 9 Miyazawa T. Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures. Surg Neurol 1998; 50: 347-351
    CrossrefPubMedGoogle Scholar
  • 10 Ammirati M, Spallone A, Ma J. et al. An anatomicosurgical study of the temporal branch of the facial nerve. Neurosurgery 1993; 33: 1038-1043
    PubMedGoogle Scholar
  • 11 Brunori A, DiBenedetto A, Chiappetta F. Transosseous reconstruction of temporalis muscle for pterional craniotomy: technical note. Minim Invasive Neurosurg 1997; 40: 22-23
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Matic DB, Kim S. Temporal hollowing following coronal incision: a prospective, randomized, controlled trial. Plast Reconstr Surg 2008; 121: 379e-385e
    CrossrefPubMedGoogle Scholar
  • 13 Steinbacher DM, Wink J, Bartlett SP. Temporal hollowing following surgical correction of unicoronal synostosis. Plast Reconstr Surg 2011; 128: 231-240
    CrossrefPubMedGoogle Scholar