Postoperative Temporalis Muscle Atrophy and the Use of Electrocautery: A Volumetric MRI Comparison

Hwang, Steven W.; Abozed, M.; Antoniou, Alexander; Malek, Adel M.; Heilman, Carl B.

doi:10.1055/s-0030-1249574

Cited by 17 publications

(17 citation statements)

References 12 publications

(30 reference statements)

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“…1,2,3,6,11,12,15,19,23,24,29 Oikawa et al published the most often referenced modification. 21 They reported cosmetically satisfactory outcomes in 100 patients, which were obtained by avoiding the use of electrocautery and dissecting the temporal muscle in a retrograde fashion.…”

Section: Aesthetic Resultsmentioning

confidence: 99%

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Prospective randomized study comparing clinical, functional, and aesthetic results of minipterional and classic pterional craniotomies

Welling¹,

Figueiredo

Wen

et al. 2015

JNS

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T he primary goal of intracranial aneurysm treatment is complete, permanent, and safe aneurysm occlusion while maintaining flow in the vessels associated with the aneurysm. Aneurysms are very diverse; therefore, the surgical approach depends in large part on the specific aneurysm to be treated, its relationship to the skull, the surrounding structures, and morphology. In this context, the pterional (PT), or frontotemporosphenoidal, approach is one of the most commonly used in vascular neurosurgery. 1,2,6,12,[26][27][28] abbreviatioNs MPT = minipterional; mRS = modified Rankin Scale; PT = pterional; ROI = region of interest. methods Fifty-eight patients with ruptured and unruptured anterior circulation aneurysms were enrolled into a prospective randomized study. The first group included 28 patients who underwent the MPT technique, and the second group comprised 30 patients who underwent the classic PT craniotomy. To evaluate the aesthetic effects, patients were asked to grade on a rule from 0 to 100 the best and the worst aesthetic result. Photographs were also taken, assessed by 2 independent observers, and classified as showing excellent, good, regular, or poor aesthetic results. Furthermore, quantitative radiological assessment (percentage reduction in thickness and volumetric analysis) of the temporal muscle, subcutaneous tissue, and skin was performed. Functional outcomes were compared using the modified Rankin Scale (mRS). Frontal facial palsy, postoperative hemorrhage, cerebrospinal fistula, hydrocephalus, and mortality were also analyzed. results Demographic and preoperative characteristics were similar in both groups. Satisfaction in terms of aesthetic result was observed in 19 patients (79%) in the MPT group and 13 (52%) in the PT group (p = 0.07). The mean score on the aesthetic rule was 27 in the MPT group and 45.8 in the PT group (p = 0.03). Two independent observers analyzed the patient photos, and the kappa coefficient for the aesthetic results was 0.73. According to these observers, excellent and good results were seen in 21 patients (87%) in the MPT and 12 (48%) in the PT groups. The degree of temporal muscle, subcutaneous tissue, and skin atrophy was 14.9% in the MPT group and 24.3% in the PT group (p = 0.01). Measurements of the temporal muscle revealed 12.7% atrophy in the MPT group and 22% atrophy in the PT group (p = 0.005). The volumetric reduction was 14.6% in the MPT and 24.5% in the PT groups (p = 0.012). Mortality and mRS score were similar in both groups at the 6-month evaluation (p = 0.99). coNclusioNs Minipterional craniotomy provides clinical results similar to those of the PT technique. Moreover, it provides better cosmetic results. It can be used safely and effectively to surgically treat aneurysms of the anterior circulation instead of the PT approach.Clinical trial registration no.: NCT01872741 (clinicaltrials.gov)

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Section: Aesthetic Resultsmentioning

confidence: 99%

“…15 In our work, this device was not included as a variable that could influence the results. Park and Hamm quantified temporal hollowing by measuring the thickness of the muscle, but again this approach reflects only a single 2D measure and may be disposed to error based on the temporal muscle reattachment.…”

Section: Radiological Atrophy Measurementsmentioning

confidence: 99%

Prospective randomized study comparing clinical, functional, and aesthetic results of minipterional and classic pterional craniotomies

Welling¹,

Figueiredo

Wen

et al. 2015

JNS

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“…Postoperatively, the deformity was no longer present, and the scalp was symmetric, bilaterally. The use of Alloderm™ implants in the frontotemporal region during cranioplasty may provide a buffer given that this area is particularly susceptible to thinner skin and muscle atrophy, as was present in our patient [8]. Additionally, given that defects in this region can lead to significant disfigurement, Alloderm™ may be used to enhance postoperative cosmetic outcomes.…”

Section: Discussionmentioning

confidence: 99%

Use of an Acellular Dermal Matrix Graft to Address a Contour Deformity in the Temporal Fossa: A Novel Application

Gupta

Oleck

Patel

et al. 2019

Cureus

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Cranioplasty of the frontotemporoparietal region is particularly challenging given the thin skin and musculature in this area, predisposing one to an increased risk of contour deformity and cosmetic dissatisfaction following surgery. Herein, we describe a 36-year-old male who initially presented with a gunshot wound (GSW) to the head and a right parietal skull fracture and underwent a revision of his cranioplasty procedure due to significant temporalis muscle atrophy, resulting in a sunken appearance of the right temporalis fossa following a craniectomy and multiple surgeries for hematoma evacuation. The patient underwent cranioplasty for definitive repair of his defect, and at follow-up, significant temporalis muscle atrophy resulted in a sunken appearance of the right temporalis fossa. A calcium phosphate bone substitute was used to fill the deformity, but dissolution and migration of the cement at follow-up necessitated a repeat cranioplasty procedure. Alloderm™ (Allergan Corp., Dublin, Ireland), an acellular dermal matrix derived from cadaveric skin, which has been previously used for dural repair, was successfully used in this study as a buffer between the skin and a cranioplasty implant to enhance cosmetic outcomes in a revision cranioplasty procedure following temporalis muscle atrophy.

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“…2 The most common complication of temporalis muscle is atrophy and also various studies have shown the atrophy of muscle after craniofacial surgeries with extensive dissection or electrocautery of the muscle causing cosmetic deformity. 3,4 However, we routinely use electrocautery while dissecting the temporalis muscle from the calvarium to minimize bleeding.…”

Section: Discussionmentioning

confidence: 99%

Massive Temporalis Muscle Swelling after Decompressive Craniectomy: Case Report

Thapa¹,

Nepal²,

Bhattarai³

et al. 2020

Eastern Green Neurosurg.

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Background: Decompressive Craniectomy is a surgical procedure in neurosurgery to handle brain swelling subsequent to trauma, vascular insult, or tumor. There are different techniques and measurements of decompressive craniectomy performed worldwide. We follow the regular trauma flap involving fronto-temporo-parietal craniectomy. There have been many complications seen in these procedures, like brain herniation, malignant swelling, hydrocephalus, infection, etc. But we have encountered quite rare complications of decompressive craniectomy which had massive swelling of the temporalis muscle leading to significant mass effect and midline shift.

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Postoperative Temporalis Muscle Atrophy and the Use of Electrocautery: A Volumetric MRI Comparison

Cited by 17 publications

References 12 publications

Prospective randomized study comparing clinical, functional, and aesthetic results of minipterional and classic pterional craniotomies

Prospective randomized study comparing clinical, functional, and aesthetic results of minipterional and classic pterional craniotomies

Use of an Acellular Dermal Matrix Graft to Address a Contour Deformity in the Temporal Fossa: A Novel Application

Massive Temporalis Muscle Swelling after Decompressive Craniectomy: Case Report

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