Temporal augmentation with calvarial onlay graft during pterional craniotomy for prevention of temporal hollowing

Abstract

BackgroundAtrophy of muscle and fat often contributes to temporal hollowing after pterional craniotomy. However, the main cause is from the bony defect. Several methods to prevent temporal hollowing have been introduced, all with specific limitations. Autologous bone grafts are most ideal for cranial defect reconstruction. The authors investigated the effectiveness of bony defect coverage and temporal augmentation using pterional craniotomy bone flap.MethodsThis study was conducted in 100 patients who underwent brain tumor excision through pterional approach from 2015 to 2016. Group 1 underwent pterional craniotomy with temporal augmentation and group 2 without temporal augmentation. In group 1, after splitting the calvarial bone at the diploic space, the inner table was used for covering the bone defect and as an onlay graft for temporal augmentation. The outcome is evaluated by computed tomography at 1-year follow-up.ResultsThe mean operative time for temporal augmentation was 45 minutes. The mean follow-up was 12 months. The ratio of temporal thickness of operated side to non-operated side was 0.99 in group 1 and 0.44 in group 2, which was statistically different. The mean visual analogue scale score was 1.77 in group 1 and 6.85 in group 2.ConclusionThis study demonstrated a surgical technique using autologous bone graft for successfully preventing the temporal hollowing and improved patient satisfaction.

Patient-specific PEEK implants for immediate restoration of temporal fossa after maxillary reconstruction with temporalis muscle flap

“…Different autogenous and biomaterials have been previously used to reconstruct the temporal area either secondary to augment an exciting deformity and restore the normal contour, or primarily to prevent temporal hollowing and immediately reconstruct the temporalis muscle donor site [ 7 , 10 , 12 – 14 ].…”

Temporal Augmentation: A Systematic Review

“…Several studies cite autologous bone graft, often calvarial, as an effective method following craniotomy to combat loss of volume in the temporal area. 66 Given the invasive nature of these procedures, they are unlikely to be used in aesthetic temporal augmentation when compared with time-saving and cost-intensive options mentioned in this review.…”

Reconstruction of temporal hollowing deformities using silicone implants made using a toy-clay model: a report of three cases

“…In 2015, Cho et al [ 7 ] introduced a surgical method to reconstruct the skull with a custom-made three-dimensional titanium implant. In 2018, Kim et al [ 8 ] used an autologous calvarial onlay graft to prevent temporal hollowing, and in 2020, Moon et al [ 9 ] introduced a method of staged reconstruction using a polyetheretherketone implant and free tissue transfer. Skull reconstruction has evolved in recent years due to the growing variety of materials and the increasing sophistication of techniques.…”