Korean J Neurotrauma.  2016 Oct;12(2):84-88. 10.13004/kjnt.2016.12.2.84.

Addition of Resection of Temporal Muscle and Fascia in Decompressive Craniectomy in the Treatment of Traumatic Brain Injury

• Yu SH
• Kim BC
• Choi JY
• Lee JI
• Cho WH
• Choi HJ

• KMID: 2356778
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.84

Abstract

OBJECTIVE
Decompressive craniectomy (DC) is a widely used surgical procedure for control of severely increased intracranial pressure in various conditions. The goal of this study is to evaluate the effectiveness of the addition of resection of temporalis muscle and fascia in DC particularly in the treatment of traumatic brain injury.
METHODS
Twenty patients underwent temporalis muscle and fascia resection in addition to conventional DC and duroplasty due to massive brain swelling in a single tertiary hospital from 2013 to 2015 were enrolled. Twenty other patients who received the standard techniques by other neurosurgeons in the same period were gathered for the control group. Postoperative computed tomography (CT) as well as functional outcome in both groups were analyzed retrospectively.
RESULTS
CT volumetry showed a significant increase of 85.19 mL (p<0.001) of extracranial herniation volume in the research group compared with the control group. Using modified Rankin Scale and Glasgow Outcome Scale, there was no statistically significant difference in functional outcome between the two groups.
CONCLUSION
Although preliminary, the procedure appears to show a meaningful increase in extracranial herniation volume with minimal masticatory and cosmetic impairment.

Keyword

Traumatic brain injury; Decompressive craniectomy; Temporal muscle

MeSH Terms

Brain Edema
Brain Injuries*
Decompressive Craniectomy*
Fascia*
Glasgow Outcome Scale
Humans
Intracranial Pressure
Neurosurgeons
Retrospective Studies
Temporal Muscle*
Tertiary Care Centers

Figure

• 

  FIGURE 1 Volumetric analysis of herniated brain parenchyme was calculated using ImageJ.

• 

  FIGURE 2 Intraoperative photograph of temporal muscle and fascia. (A) Dissected muscle and fascia with a pericranial flap elevated from the temporal fossa. (B) The resected muscle and fascia being measured.

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