SpringerLink
Log in

Preservation of the temporal muscle during the frontotemporoparietal approach for decompressive craniectomy: Technical note

  • Technical Note - Neurosurgical Techniques
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

In patients undergoing decompressive craniectomy, resection and detachment of the temporal muscle produces esthetic and functional damage, due to atrophy of the frontal portion of the temporal muscle in the temporal fossa. We have performed en-block temporal muscle detachment in decompressive craniectomy patients to avoid esthetic and functional damage to the temporal muscle.

Methods

Twenty-one patients underwent decompressive craniectomy using a frontotemporoparietal approach. Through a three-leaf clover flap skin incision, the temporal muscle was detached en-block and overturned antero-inferiorly conjoined with the frontal myocutaneous flap. A decompressive craniectomy and duraplasty were performed. A polyethylene sheet was added to prevent adherence of the temporal muscle to the dura mater.

Results

The decompressive craniectomy was effective in all patients. When subsequent cranioplasty was performed, the temporal muscle was easily repositioned. No complications resulted from the en-block temporal muscle detachment or the use of the polyethylene sheet. In 18 patients eligible for clinical and radiological follow-up, excellent (n = 4) or good (n = 14) esthetic results were detected. Chewing ability is considered normal by all patients.

Conclusion

Although it requires that the patient undergo two surgical procedures, en-block detachment of the temporal muscle during decompressive craniectomy allows good esthetic and functional results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Abbott KH (1953) Use of frozen cranial bone flaps for autogenous and homologous grafts in cranioplasty and spinal interbody fusion. J Neurosurg 10:380–388

    Article  PubMed  CAS  Google Scholar 

  2. Abuzayed B, Tuzgen S, Canbaz B, Yuksel O, Tutunculer B, Sanus GZ (2009) Reconstruction of growing skull fracture with in situ galeal graft duraplasty and porous polyethylene sheet. J Craniofac Surg 20:1245–1249

    Article  PubMed  Google Scholar 

  3. Adamo MA, Drazin D, Waldman JB (2009) Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries. J Neurosurg Pediatr 3:334–339

    Article  PubMed  Google Scholar 

  4. Boongird A, Bingaman WE (2008) Anatomical hemispherectomy. In: Starr P, Barbaro N, Larson P (eds) Functional neurosurgery, 2nd edn. Thieme Medical Publisher, New York, pp 49–55

    Google Scholar 

  5. Brown MH, Grindlay JH, Craig WM (1947) The use of polythene film as a dural substitute; a preliminary report. J Neurosurg 4:505–507

    Article  PubMed  CAS  Google Scholar 

  6. Busch E, Bing J, Hansen EH (1949) Gelatine and polythene film as dura substitutes and polythene plates as bone substitute in skull defects. Acta Chir Scand 97:410–416

    PubMed  CAS  Google Scholar 

  7. Fowler FD, Ingraham FD (1957) A new method for applying polyethylene film to the skull in the treatment of craniosynostosis. J Neurosurg 14:584–586

    Article  PubMed  CAS  Google Scholar 

  8. Greenberg M (2010) Operations and procedures. In: Handbook of neurosurgery, 7th edn. Thieme Publishers, New York, 144–221

  9. Ingraham FD, Alexander E, Matson DD (1947) Polyethylene, a new synthetic plastic for use in surgery. Experimental application in neurosurgery. JAMA 135:82–87

    Article  CAS  Google Scholar 

  10. Ingraham FD, Alexander E, Matson DD (1949) The use of synthetic plastic materials in surgery. Practitioner 162:152–159

    PubMed  CAS  Google Scholar 

  11. Kasper EM, Ridgway EB, Rabie A, Lee BT, Chen C, Lin SJ (2012) Staged scalp soft tissue expansion before delayed allograft cranioplasty: a technical report. Neurosurgery 71(1 Suppl Operative):15–20

    PubMed  Google Scholar 

  12. Missori P, Polli FM, Fontana E, Delfini R (2003) Closure of skin or scalp with absorbable sutures. Plast Reconstr Surg 112:924–925

    PubMed  Google Scholar 

  13. Missori P, Polli FM, Peschillo S, D’Avella E, Paolini S, Miscusi M (2008) Double dural patch in decompressive craniectomy to preserve the temporal muscle: technical note. Surg Neurol 70:437–439

    Article  PubMed  Google Scholar 

  14. Final report on the safety assessment of polyethylene (2007) Int J Toxicol. 26 Suppl 1:115–127.

    Google Scholar 

  15. Ragel BT, Klimo P Jr, Martin JE, Teff RJ, Bakken HE, Armonda RA (2010) Wartime decompressive craniectomy: technique and lessons learned. Neurosurg Focus 28:E2

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurology and Psichiatry, Neurosurgery, University of Rome “Sapienza”, Rome, Italy

    Paolo Missori & Maurizio Domenicucci

  2. Neurosurgery, University of Rome “Sapienza”, IRCCS Neuromed-Pozzilli, Rome, Italy

    Sergio Paolini

  3. Neurosurgery, University Bari Medical School, Bari, Italy

    Pasqualino Ciappetta

  4. University Hospital Center Mother Theresa, Tirana, Albania

    Arsen Seferi

Authors
  1. Paolo Missori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sergio Paolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pasqualino Ciappetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arsen Seferi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maurizio Domenicucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Missori.

Additional information

Comment

Straightforward paper, clearly written and convincingly illustrated. There is no really novel information; however, and the technique presented is not to be intended as “our solution”. I think that this technique is a suitable option and not a must.

Domenico d’Avella

Padova, Italy

Rights and permissions

Reprints and permissions

About this article

Cite this article

Missori, P., Paolini, S., Ciappetta, P. et al. Preservation of the temporal muscle during the frontotemporoparietal approach for decompressive craniectomy: Technical note. Acta Neurochir 155, 1335–1339 (2013). https://doi.org/10.1007/s00701-013-1695-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1695-z

Keywords

Search

Navigation