Reconstruction of the temporalis muscle for pterional and cranio-orbital craniotomies

Bowles, Alfred P.

doi:10.1016/s0090-3019(99)00112-3

Cited by 30 publications

(20 citation statements)

References 6 publications

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“…In this region the defect is obviously more exposed due to the incomplete hair coverage. Atrophy of the temporal muscle seems to be an additional factor in our patient series, which is associated with aesthetic and functional problems after pterional craniotomy and reconstruction of the pterional region (16)(17). In our 9 study, unsatisfied patients complained most likely about the dented aesthetic look or temporal wasting as previously described by Raza et al, which may lead to functional disturbances such as chewing problems (16).…”

Section: Discussionsupporting

confidence: 62%

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Fischer

Burkhardt

Sarnthein

et al. 2012

Neurological Research

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OBJECTIVES: Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA) cranioplasty in this study using a questionnaire. METHODS: A patient questionnaire was developed to evaluate the grade of satisfaction after surgery. After approval by the institutional ethical review board, we were allowed to send to all 115 patients, who received a cranioplasty from 2001 to 2008 at the University Hospital of Zurich, our questionnaire once to retrospectively analyze the patient response together with the patient hospital records. RESULTS: Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79 patients. Sixty-three of 79 patients replied to the questionnaire (79·7%) and 16 did not reply. Seventeen declined to participate in this study and out of the remaining 46 patients (58·2%, 18 women, mean age 54 years, range 20-83 years), who agreed to participate in this study, 22 (47·8%) judged their cranioplasty to be aesthetically 'excellent', 16 (34·8%) 'favorable' and 4 (8·7%) 'poor'. Another four patients (8·7%) were not satisfied, asking for a surgical revision. Patient age and gender was not related to the assessment of the aesthetic result. A higher satisfaction grade was found in patients with primary PMMA cranioplasty compared to PMMA cranioplasty implanted during a second surgery (Fisher's exact test, P = 0·031). A dent was strongly associated with absence of satisfaction (P<0·01, Fisher's exact test). CONCLUSION: Our questionnaire was suitable to assess patient satisfaction after cranioplasty. Localization of cranioplasty showed to be an important factor of aesthetic outcome, especially in the fronto-temporal region where a carefully planned reconstruction should be performed to guarantee an excellent grade of satisfaction after surgery. AbstractObjectives Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA) cranioplasty in this study using a questionnaire.Methods A patient questionnaire was developed to evaluate the grade of satisfaction after Results Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79 patients. 63 of 79 patients replied to the questionnaire (79.7%) and 16 did not reply. 17 declined to participate in this study and out of the remaining 46 patients (58.2%, 18women, mean age 54y, range 20-83y), who agreed to participate in this study, 22 (47.8%) judged their cranioplasty to be aesthetically "excellent", 16 (34.8%) "favorable" and 4 (8.7%) "poor". Another 4 patients (8.7%) were not satisfied, asking for a surgical revision. Patient age and gender was not related to the assessment of the aesthetic result. A higher satisfact...

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Section: Discussionsupporting

confidence: 62%

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Fischer

Burkhardt

Sarnthein

et al. 2012

Neurological Research

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“…An insertion tendon cuff is also preserved along the insertion line of the temporalis muscle for future reattachment and improved functionality [5,6,25,35].…”

Section: Surgical Techniquementioning

confidence: 99%

The frontotemporal-orbitozygomatic approach: reconstructive technique and outcome

et al. 2012

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“…33 Oikawa et al 20 noted the avoidance of temporal atrophy by preserving the deep temporal nerve and artery by means of retrograde dissection without damage to the subperiosteum. Despite various temporal resuspension and fixation techniques, [34][35][36][37][38][39] however, inappropriate reattachment with undue muscle tension and muscle fiber damage from monopolar cauterization 13,20 contributes to postoperative muscle atrophy and contraction, leading to temporal hollowing and possible painful mastication.…”

Section: Indications and Complicationsmentioning

confidence: 99%

Frontotemporal-Orbitozygomatic Approach

Balasingam

McMenomey

Delashaw

2005

Neurosurgery Quarterly

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The frontotemporal-orbitozygomatic (FTOZ) approach developed by Hakuba in 1977 as an osteoblastic bone flap for tumoral and aneurysmal pathologic findings offers a craniotomy with a wide shallow working area and optimal brain exposure with minimal brain retraction. This procedure provides a low vantage point with a wide angle of exposure to the contents of the inferior frontal lobe, parasellar region, cavernous sinus, interpeduncular cisterns, and floor of the anterior and middle fossa. Most procedure variations are fashioned in a nonosteoplastic fashion using deep structures such as the inferior orbital fissure and/or the superior orbital fissures. Unfortunately, published articles have drawn little attention to the cosmesis and complexity of the procedure. A simpler and less timeconsuming FTOZ craniotomy approach compared with previous reports is recommended here. An osteoplastic technique with improved long-term cosmesis that eliminates the necessity of use of the inferior orbital fissures with no need to expose the malar eminence and, if required, translocation of the temporal process of the zygoma rather than removal with the bone flap is discussed. The authors present techniques with cadaveric and skull models for performing a simplified osteoplastic FTOZ craniotomy via 3 procedures (1-piece, 2-piece, and modified) and discuss the merits and use of each procedure. Although the procedures can be performed in a nonosteoplastic fashion, the osteoplastic method is recommended for longterm cosmesis and good functional outcome. The authors' preference for most pathologic lesions treated is the modified procedure because of its simplicity, ease, adequate exposure, and shorter required operating time.T he frontotemporal-orbitozygomatic (FTOZ) approach was developed in 1977 and first introduced into the neurosurgical armamentarium in 1986 by Hakuba and colleagues. 1 It was a 1-piece osteoplastic bone flap with the intent of providing excellent exposure obliquely of the parasellar region and the interpeduncular fossa with the shortest possible working distance. Many variations have emerged since the original description as a 1-piece or 2-piece procedure. 2-17 Most investigators suggested a nonosteoplastic craniotomy, with the exception of 1 group, 17 and the cosmesis of such interventions, principally of temporal muscle atrophy with asymmetry and slumping, resulting in temporal fossa depression is seldom addressed. In addition, the devascularization of the free bone flap with antecedent atrophy and suboptimal healing along the craniotomy line with a heightened risk of infection is not mentioned.This article describes the technical details of performing a simple but easy osteoplastic FTOZ via 3 avenues: 1-piece procedure, 2-piece procedure, and modified 1-piece procedure. The simplicity of the technique is attributed to the lack of need for the use of the inferior orbital fissures in the procedure. Furthermore, the zygomatic arch is not removed separately or as part of the bone flap but is rather translocated with the...

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Reconstruction of the temporalis muscle for pterional and cranio-orbital craniotomies

Cited by 30 publications

References 6 publications

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

The frontotemporal-orbitozygomatic approach: reconstructive technique and outcome

Frontotemporal-Orbitozygomatic Approach

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