Dysfunction of the temporalis muscle following pterional craniotomy: Analysis of 20 cases

Authors

  • Muhammad Mukhtar Khan Department of Neurosurgery, Northwest General Hospital & Research Centre, Peshawar
  • FAIQA FILZA KHAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • MUHAMMAD IDRESS Khyber Teaching Hospital, Peshawar
  • MUHAMMAD NAWAZ Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • KHIAL JALAL Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • IRFAN JAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • SOHAIL DAUD KHAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • TARIQ KHAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar

Keywords:

Temporalis muscle dysfunction, pterional craniotomy, postoperative complications

Abstract

Background & Objectives: Temporalis muscle dysfunction following pterional approach for skull base approaches is commonly encountered which is very discomforting for patients however, literature regarding its management is insufficient. This study presents 20 cases over the course of 4 years and discuss the pitfalls in the management of temporalis muscle dysfunction following pterional craniotomy for various lesions.
Materials and Methods: Sixty patients were operated using the pterional craniotomy, out of which 20 patients were included in the study. In these cases we used three methods of temporalis muscle dissection namely, the submuscular, subfascial & interfascial. Postoperatively, patients were followed for a median of 8 months. Detailed description of the follow-up findings and their statistical associations is presented.
Results: Twenty patients with 12 (60%) males & 8 (40%) females with mean age of 43.8 ± 10.9 years were operated. Twelve (60%) patients were operated using the submuscular approach, 6 (30%) by the subfascial method and 2 (10%) by interfascial technique of temporalis muscle dissection. Of the 20 patients, 8 (40%) reported trismus, 10 (50%) had temporal region and jaw pain and 14 (70%) complained of difficulty chewing. For these patients, we employed local heat therapy (n = 14, 70%), chewing exercises (n = 12, 60%) and oral range-of-motion exercises (n = 9, 45%). 78.5% of patients responded with resolution of pain after local heat therapy, 80% with jaw range-of-motion exercises. The temporal hollowing was assessed by plastic surgeon, but none of the patient pursued plastic surgery intervention.
Conclusion: Temporalis muscle dysfunction following pterional craniotomy occurs in about one-third of patients. It is a cause of significant patient concern. Physiotherapy and oral analgesics can alleviate the common symptoms. Patients must be informed about this complication to avoid undue psychological distress. Early diagnosis & management leads to better patient response.

References

1. Yasargil MG, Reichman MV, Kubik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. J Neurosurg. 1987; 67 (3): 463-6.
2. MG Y. Microneurosurgery. Stuttgart: Georg Thieme Verlag; 1984.
3. Aziz KM, Froelich SC, Cohen PL, Sanan A, Keller JT, van Loveren HR. The one-piece orbitozygomatic approach: the MacCarty burr hole and the inferior orbital fissure as keys to technique and application. Acta Neurochir (Wien). 2002; 144 (1): 15-24.
4. Miller ML, Kaufman BA, Lew SM. Modified osteoplastic orbitozygomatic craniotomy in the pediatric population. Childs Nerv Syst. 2008; 24 (7): 845-50.
5. Pieper DR, Al-Mefty O. Cranio-orbito-zygomatic approach. Operative Techn Neurosurg. 1999; 2 (1): 2-9.
6. Santiago GF, Terner J, Wolff A, et al. Post-Neurosurgical Temporal Deformities: Various Techniques for Correction and Associated Complications. J Craniofac Surg. 2018; 29 (7): 1723-9.
7. Tanriover N, Ulm AJ, Rhoton AL, Jr., Kawashima M, Yoshioka N, Lewis SB. One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations. Neurosurgery, 2006; 58 (4 Suppl. 2): ONS-229-37; Discussion ONS-37.
8. Su-Gwan K. Treatment of temporomandibular joint ankylosis with temporalis muscle and fascia flap. Int J Oral Maxillofac Surg. 2001; 30 (3): 189-93.
9. Balasingam V, Noguchi A, McMenomey SO, Delashaw JB, Jr. Modified osteoplastic orbitozygomatic craniotomy. Technical note. J Neurosurg. 2005; 102 (5): 940-4.
10. Davidge KM, van Furth WR, Agur A, Cusimano M. Naming the soft tissue layers of the temporoparietal region: unifying anatomic terminology across surgical disciplines. Neurosurgery, 2010; 67 (3 Suppl. Operative): Ons 120-9; Discussion Ons 9-30.
11. Rocha-Filho PA, Fujarra FJ, Gherpelli JL, Rabello GD, de Siqueira JT. The long-term effect of craniotomy on temporalis muscle function. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104 (5): e17-21. 12. Kim S, Matic DB. The anatomy of temporal hollowing: the superficial temporal fat pad. J Craniofac Surg. 2005; 16 (5): 760-3.
13. Kim JH, Lee R, Shin CH, Kim HK, Han YS. Temporal augmentation with calvarial onlay graft during pterional craniotomy for prevention of temporal hollowing. Arch Craniofac Surg. 2018; 19 (2): 94-101.
14. Im SH, Song J, Park SK, Rha EY, Han YM. Cosmetic Reconstruction of Frontotemporal Depression Using Polyethylene Implant after Pterional Craniotomy. Biomed Res Int. 2018; 2018: 1982726.
15. de Andrade Junior FC, de Andrade FC, de Araujo Filho CM, Carcagnolo Filho J. Dysfunction of the temporalis muscle after pterional craniotomy for intracranial aneurysms. Comparative, prospective and randomized study of one flap versus two flaps dieresis. Arq Neuropsiquiatr. 1998; 56 (2): 200-5.
16. Rocha-Filho PA, Gherpelli JL, de Siqueira JT, Rabello GD. Post-craniotomy headache: characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms. Cephalalgia. 2008; 28 (1): 41-8.
17. Abdulazim A, Filis A, Sadr-Eshkevari P, Schulte F, Sandu N, Schaller B. Postcraniotomy function of the temporal muscle in skull base surgery: technical note based on a preliminary study. Scientific World Journal, 2012; 2012: 427081.
18. Vaca EE, Purnell CA, Gosain AK, Alghoul MS. Postoperative temporal hollowing: Is there a surgical approach that prevents this complication? A systematic review and anatomic illustration. J Plast Reconstr Aesthet Surg. 2017; 70 (3): 401-15.
19. Zager EL, DelVecchio DA, Bartlett SP. Temporal muscle microfixation in pterional craniotomies. Technical note. J Neurosurg. 1993; 79 (6): 946-7.
20. Matic DB, Kim S. Temporal hollowing following coronal incision: a prospective, randomized, controlled trial. Plast Reconstr Surg. 2008; 121 (6): 379e-85e.
21. Bowles AP, Jr. Reconstruction of the temporalis muscle for pterional and cranio-orbital craniotomies. Surg Neurol. 1999; 52 (5): 524-9.
22. Kawaguchi M, Sakamoto T, Furuya H, Ohnishi H, Karasawa J. Pseudoankylosis of the mandible after supratentorial craniotomy. Anesth Analg. 1996; 83 (4): 731-4.
23. Chowdhury T, Garg R, Sheshadri V, et al. Perioperative Factors Contributing the Post-Craniotomy Pain: A Synthesis of Concepts. Frontiers in medicine, 2017; 4: 23.

Downloads

Published

2019-06-04

Issue

Section

Original Articles