J Korean Neurotraumatol Soc.  2011 Oct;7(2):78-82. 10.13004/jknts.2011.7.2.78.

The Efficacy of Temporal Mesh Plate Floating Technique for Keyhole Site Depression after Frontotemporal Craniotomy

• Lee MS
• Lee YS
• Lee JH
• Ryu KY
• Kang DG

• KMID: 2019918
• DOI: http://doi.org/10.13004/jknts.2011.7.2.78

Abstract

OBJECTIVE
The keyhole site depression is the major cosmetic problem after the frontotemporal craniotomy. Keyhole site bone defect and the temporalis muscle atrophy are the main causes of the keyhole site depression. The purpose of this study is to evaluate the efficacy of temporal mesh plate floating technique for keyhole site depression.
METHODS
Total 109 patients who underwent frontotemporal craniotomy from January 2009 to December 2010 were enrolled in this study. The temporal mesh plate floating techniques were performed in 55 patients (Group A), and no other supporting materials were used in the remaining 54 patients (Group B). Each group was divided into single and repeated craniotomy groups for the reason that the repeated craniotomy might result in more severe keyhole site depression. The depth of keyhole site was measured from at least 3-month postoperative brain computed tomography, and the rate of depression was recorded in percentage by comparing to the contralateral side.
RESULTS
The overall rate of keyhole site depression was 11.60% in group A with 9.70% in single craniotomy group and 22.75% in repeated craniotomy group, respectively. The overall rate was 44.57% in group B with 41.43% in single craniotomy group and 49.50% in repeated craniotomy group, respectively. The rate of depression was evidently more severe in group B than group A with statistical significance.
CONCLUSION
Temporal mesh plate floating technique is very easy and cost-effective method to reconstruct temporalis muscle, and is useful to prevent keyhole site depression after frontotemporal craniotomy.

Keyword

Temporal muscle; Craniotomy; Surgical technique

MeSH Terms

Brain
Cosmetics
Craniotomy
Depression
Humans
Muscles
Muscular Atrophy
Temporal Muscle
Cosmetics

Figure

• 

  FIGURE 1 Prominent keyhole site depression one year after frontotemporal craniotomy.

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  FIGURE 2 The depth of keyhole site was measured from at least 3-month postoperative brain computed tomography (CT), and the rate of depression was recorded in percentage by comparing to the contralateral side (yellow lines). A: Severe keyhole site depression (white arrow) is seen after Rt frontotemporal craniotomy without temporal mesh plate. B: Minimal keyhole site depression (white arrow) is seen after Rt frontotemporal craniotomy using temporal mesh plate. Note the floating configuration (black arrow head) of temporal mesh plate between the keyhole and temporalis muscle.

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  FIGURE 3 Photograph of temporal mesh plate (Synthes GmbH, Oberdorf, Switzerland). It is easily bent into 3-dimensional shape to fit underlying bony contour.

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  FIGURE 4 Intraoperative image (A) and postoperative three-dimensional computed tomography (B) show temporal mesh plate covering the bony defect at the keyhole site. The superior portion of the temporal mesh plate is fixed to the bone flap with self-tapping screws, and the inferior portion is designed to float with some gaps above the bone.

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