1
|
Kweon GY, Park J, Son W. Acceptable durability of split inner table graft for the reconstruction of a bone defect in pterional craniotomies: a case series. Front Surg 2023; 10:1213648. [PMID: 37520153 PMCID: PMC10375404 DOI: 10.3389/fsurg.2023.1213648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Objective During a pterional craniotomy, the bone defect was reconstructed by a surgical technique using an autogenous bone graft instead of commercially available alloplastic materials. The technical feasibility, durability of the grafted bone, and cosmetic outcome were all evaluated. Methods After a pterional craniotomy was performed, the bone defect at the frontobasal burr hole and drilled sphenoid wing was reconstructed using an autogenous split inner table graft (1 cm × 2 cm) harvested from the craniotomy bone flap. Results The bone reconstruction technique was successfully performed on nine patients with intracranial aneurysms. After 12-19 months from the surgery, a volumetry study using three-dimensional skull images reconstructed from computed tomography angiography showed a minimal decrease in the area of the split inner table graft due to bone resorption in six patients, which ranged from 5.7% to 14.8%. In the other three patients, the bone resorption was more substantial, ranging from 21.2% to 27.5%. However, in the three latter cases, the resorption was mainly limited to the posterior part of the split inner table graft covered by the temporalis muscle and did not affect the cosmetic outcomes. The resultant cosmetic outcomes for the nine patients were all favorable, with only a slight or no anterior temporal hollow. Conclusion The proposed surgical technique using a split inner table graft harvested from the craniotomy bone flap seems viable for reconstructing the bone defect at the frontobasal burr hole and drilled sphenoid wing after a pterional craniotomy.
Collapse
|
2
|
Morandi EM, Pinggera D, Kerschbaumer J, Rauchenwald T, Winkelmann S, Thomé C, Pierer G, Wolfram D. Correction of temporal hollowing after pterional craniotomy by autologous fat grafting. A single-center experience. World Neurosurg 2022; 164:e784-e791. [PMID: 35597536 DOI: 10.1016/j.wneu.2022.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aesthetic complications following neurosurgical procedures impact patient quality of life and self-perception. Postoperative temporal hollowing is frequently seen after temporal craniotomy, resulting mainly from atrophy of the temporal muscle. Autologous fat grafting is a tailorable method to correct such approach-related sequelae. We herein present our clinical patient series and discuss pearls and pitfalls of this method. METHODS In this retrospective single-center study, correction of postoperative temporal hollowing using autologous fat grafting was performed in 16 patients. Temporal tissue thickness ratio was measured using magnetic resonance tomography images to visualize the graft. Patients, plastic surgeons and neurosurgeons evaluated the results independently using the herein presented scale. RESULTS The mean interval between the neurosurgical procedure and fat grafting was 62 months. A mean volume of 11.5 ml autologous fat was injected in an average of 2.5 sessions after initial rigotomy. Temporal tissue thickness was significantly augmented at a mean of 2.2 years after the operation (mean 0.71 ± 0.25, range 0.43-1.1; p=0.0214) as compared to the preoperative finding (mean 0.48 ± 0.1, range 0.32-0.6). Patients were more satisfied with the results than were surgeons, reflecting the significant impact of the deformity on patient self-esteem. CONCLUSIONS Autologous fat grafting is a valuable method for correcting postoperative temporal hollowing that provides stable results, high patient and surgeon satisfaction and can be tailored to the patient's individual needs. It should not be considered a merely aesthetic operation, but an important rehabilitation step towards restoring the patient's quality of life.
Collapse
Affiliation(s)
- Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Selina Winkelmann
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| |
Collapse
|
3
|
Ali S, Abdel Aziz O, Ahmed M. Patient-specific PEEK implants for immediate restoration of temporal fossa after maxillary reconstruction with temporalis muscle flap. Maxillofac Plast Reconstr Surg 2022; 44:20. [PMID: 35524015 PMCID: PMC9076787 DOI: 10.1186/s40902-022-00348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Temporal hollowing is a common complication following the rotation of the temporalis muscle that leaves the patient with a cosmetic impairment. Several alloplastic materials have been used to reconstruct the donor site; however, these implants need meticulous adaptation to conform the periphery of the defect and restore the contour of the temporal area. The aim of this study was to assess the use of patient-specific polyetheretherketone (PEEK) temporal implants to prevent temporal hollowing following the use of full temporalis muscle flap for large maxillary defects reconstruction. METHODS This was a prospective study conducted on eight patients with major maxillary defects indicating the need of reconstruction with full temporalis muscle flap or any lesion indicating major maxillary resection and immediate reconstruction with total temporalis muscle flap. For each patient, a patient-specific PEEK implant was fabricated using virtual planning and milled from PEEK blocks. In the surgical theater, the temporalis muscle was exposed, elevated, and transferred to the maxilla. After the temporalis muscle transfer, PEEK implants were fixed in place to prevent temporal hollowing. RESULTS The surgical procedures were uneventful for all patients. The esthetic result was satisfactory with no post-operative complications except in one patient where seroma occurred after 2 weeks and resolved after serial aspiration. CONCLUSION Patient-specific PEEK implant appears to facilitate the surgical procedures eliminate several meticulous steps that are mainly based on the surgeon's experience. TRIAL REGISTRATION Clinical trials registration: NCT05240963 .
Collapse
Affiliation(s)
- Sherif Ali
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Omniya Abdel Aziz
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mamdouh Ahmed
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Oral and Maxillofacial Surgery Department, Nasser Institute for Treatment and Research, Cairo, Egypt
| |
Collapse
|
4
|
Shay T, Shachar T, Olshinka A, Ad-El DD, Ibelli T, Yaacobi DS. Temporal Hollowing Causes, Classifications, and Treatment Options: A Systematic Review. J Cosmet Dermatol 2022; 21:4215-4224. [PMID: 35467073 DOI: 10.1111/jocd.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent developments in surgical techniques and grading schemas to treat temporal hollowing necessitate critically assessing their efficacy. This systematic review presents the currently available protocols for temporal hollowing, aimed toward improving the clinical approach, for the benefit of the surgeon and patient. METHODS A search was conducted in Pubmed, Embase, and Google Scholar in September 2021 using the key words "temporal hollowing" and "temporal augmentation." Inclusion criteria were English written articles published in peer-reviewed journals that reported an outcome relating to the cause, classification, or procedure used to prevent or correct hollowing in humans. RESULTS Of the 413, 966 publications retrieved, 24 met the study inclusion criteria. Twenty-one publications discussed the etiology of temporal hollowing, 12 discussed a classification or grading system for temporal hollowing, and 19 discussed a procedure to prevent or correct temporal hollowing. The most commonly reported etiology for temporal hollowing was iatrogenic (63%). For classifying temporal hollowing severity, visual analogue scales (25%) were most commonly used. Mesh (26%) and autologous fat grafts (26%) were the most popular procedures used to prevent or correct temporal hollowing. DISCUSSION We presented the spectrum of temporal hollowing grading schemas and treatment modalities currently published in the field. The use, by a majority of publications, of a grading system based on the subjective judgement of the examiner (either alone or adjunct to imaging results) suggests the need for a more standardized measurement tool. Future studies should investigate a universally-applicable temporal hollowing classification system and its impact on treatment outcomes.
Collapse
Affiliation(s)
- Tamir Shay
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Tal Shachar
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Asaf Olshinka
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Dean D Ad-El
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Taylor Ibelli
- Sackler School of Medicine at, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Shilo Yaacobi
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| |
Collapse
|
5
|
Kim MW, Kim SH, Nam SB, Lee JW, Jeong DK, Kim YH. Reconstruction of temporal hollowing deformities using silicone implants made using a toy-clay model: a report of three cases. Arch Craniofac Surg 2022; 23:34-38. [PMID: 35255594 PMCID: PMC8901594 DOI: 10.7181/acfs.2021.00479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Severe temporal hollowing deformities can occur in patients who undergo craniectomy after intracranial hemorrhage. Reconstruction surgery for cosmetic purposes using silicone implants in patients with temporal hollowing deformities after craniectomy is advantageous because the procedure is simple and rapid, with a short recovery time, resulting in lower overall treatment costs. Of paramount importance, this option yields highly satisfactory results for patients. The authors present three cases of simple and fast surgery using silicone implants where highly satisfactory outcomes were obtained.
Collapse
Affiliation(s)
- Min Wook Kim
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Seung Hyun Kim
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Bong Nam
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Jae Woo Lee
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Dae Kyun Jeong
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Correspondence: Young Ha Kim Department of Neurosurgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea E-mail:
| |
Collapse
|
6
|
Gonçalves DB, Dos Santos MIA, de Cristo Rojas Cabral L, Oliveira LM, da Silva Coutinho GC, Dutra BG, Martins RV, Reis F, Paiva WS, de Amorim RLO. Esthetics outcomes in patients submitted to pterional craniotomy and its variants: A scoping review. Surg Neurol Int 2021; 12:461. [PMID: 34621576 PMCID: PMC8492413 DOI: 10.25259/sni_485_2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Highly performed nowadays, the pterional craniotomy (PC) has several widespread variants. However, these procedures are associated with complications such as temporalis muscle atrophy, facial nerve frontal branch damage, and masticatory difficulties. The postoperative cranial aesthetic is, nonetheless, the main setback according to patients. This review aims to map different pterional approaches focusing on final aesthetics. Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies were classified through the Oxford method. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library from January 1969 to February 2021 for cohorts and randomized clinical trials that met our inclusion criteria. Results: 1484 articles were initially retrieved from the databases. 1328 articles did not fit the inclusion criteria. 118 duplicates were found. 38 studies were found eligible for the established criteria. 27 (71.05%) were retrospective cohorts, with low evidence level. Only 5 (13.15%) clinical trials were found eligible to the criteria. The majority of the studies (36/38) had the 2B OXFORD evidence level. A limited number of studies addressed cosmetic outcomes and patient satisfaction. The temporal muscle atrophy or temporal hollowing seems to be the patient’s main complaint. Only 17 (44.73%) studies addressed patient satisfaction regarding the aesthetics, and only 10 (26.31%) of the studies reported the cosmetic outcome as a primary outcome. Nevertheless, minimally invasive approaches appear to overcome most cosmetic complaints and should be performed whenever possible. Conclusion: There are several variants of the classic PC. The esthetic outcomes are poorly evaluated. The majority of the studies were low evidence articles.
Collapse
Affiliation(s)
- Daniel Buzaglo Gonçalves
- Department of Neurosurgery, Getúlio Vargas University Hospital, Federal University of Amazonas, Manaus
| | | | | | - Louise Makarem Oliveira
- Department of Neurosurgery, Getúlio Vargas University Hospital, Federal University of Amazonas, Manaus
| | | | - Bruna Guimarães Dutra
- Department of Neurosurgery, Getúlio Vargas University Hospital, Federal University of Amazonas, Manaus
| | | | - Franklin Reis
- Department of Neurosurgery, Getúlio Vargas University Hospital, Federal University of Amazonas, Manaus.,Faculty of Medicine, Faculdade Metropolitana de Manaus, Manaus
| | - Wellingson Silva Paiva
- Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo.,Department of Neurology, Hospital Samaritano de São Paulo, São Paulo, Brazil
| | - Robson Luis Oliveira de Amorim
- Department of Neurosurgery, Getúlio Vargas University Hospital, Federal University of Amazonas, Manaus.,Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo
| |
Collapse
|
7
|
O'Connor KP, Pelargos PE, Palejwala AH, Shi H, Villeneuve L, Glenn CA. Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Operative Video. World Neurosurg 2019; 127:518-524. [DOI: 10.1016/j.wneu.2019.04.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022]
|