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. 2024 Jun 20;20(2):101-107.
doi: 10.13004/kjnt.2024.20.e22. eCollection 2024 Jun.

Unseparated Temporal Muscle and Duramater Cranioplasty Methods Following Decompressive Craniectomy: Technical Note

Hanif Gordang Tobing  1 , Fabianto Santoso  1 , Ricky Rusydi Satriawan  1 , Zharifah Fauziyyah Nafisah  1 , Bipatra Einstein Yacobus Paat  1 , Theresia Meiske Laura Siscawati Wayne  1
Affiliations

Unseparated Temporal Muscle and Duramater Cranioplasty Methods Following Decompressive Craniectomy: Technical Note

Hanif Gordang Tobing et al. Korean J Neurotrauma. .

Abstract

Objective: Cranioplasty (CP) is used to repair cranial defects after decompressive craniectomy. During this procedure, the temporal muscle can contract or retract toward the base and adhere to the scalp flaps above and/or below the dura. Several complications including functional and cosmetic problems can occur following CP. This study presents the technical notes and outcomes of CP.

Methods: This retrospective observational study collect data of CP-procedures using unseparated muscle-dura technique performed at our hospital in 2019-2022. Technical note is presented regarding the lack of separation of the temporal muscles from the dura mater. A bone flap or titanium mesh was placed above the temporal muscle layer, which was still attached to the dura mater. Functional outcomes were evaluated using OHIP-14 Questionnaire to assess mastication quality.

Results: Twenty-three patients were included in this study. Initial surgeries were mostly caused by trauma (65.2%). Most patients underwent autologous bone flap CP (52.2%), during which the bone flap was stored in either the abdominal subcutaneous pocket or cryoprecipitated. Only one patient experienced mastication problems after CP (p<0.001). Temporal hollowing remained a problem in this technique. However, dissection of the temporalis muscle to reduce temporal hollowing can cause facial nerve injuries and masticatory problems. Due to the lack of temporal muscle manipulation, our patients had minimal mastication problems.

Conclusion: CP should be performed to improve functional and aesthetic outcomes. A CP technique with the temporal muscle unseparated from the dura mater can be selected to avoid damage to the muscle and mastication problems after surgery.

Keywords: Decompressive craniectomy; Mastication; Reconstructive surgical procedures; Treatment outcome.

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Conflict of interest statement

Conflict of Interest: The authors have no financial conflicts of interest.

Figures

FIGURE 1
FIGURE 1. Cranioplasty technique illustration. (A) Illustration of cranioplasty technique without separating the layer of temporal muscle and duramater. The layer after opening the skin and galea flap showed the temporal muscle and dura were attached in the cranial defect. (B) The bone flap was placed in the defect above the layer of temporal muscle and duramater.
FIGURE 2
FIGURE 2. Layers of Scalp before and after cranioplasty. (A) Illustration of normal scalp, muscle, cranium, and meninges layers before decompressive craniectomy. (B) Layers of scalp until meninges after cranioplasty showed bone placed above the temporal muscle.
FIGURE 3
FIGURE 3. Documentation of surgical steps of cranioplasty. (A) Skin incision followed the previous surgical design. (B)Cranioplasty technique showed skin flap dissection to and suspended cranially. (C) Placement of the autologous bone flap above the layer of temporal muscle and duramater (courtesy of Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital).
FIGURE 4
FIGURE 4. Oral health impact profile before and after cranioplasty.
OHIP: Oral Health Impact Profile.
See this image and copyright information in PMC

Comment in

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