Reconstruction of the temporalis muscle for pterional and cranio-orbital craniotomies

BACKGROUND Atrophy of the temporalis muscle can result after dissection and reattachment with pterional and cranio-orbital craniotomies. To prevent this sequel, a number of surgical modifications have been used to preserve the deep temporal nerve and artery, and also to allow for reconstruction of the temporalis muscle with minimal damage. In this report another surgical modification for reconstruction of the temporalis muscle is described that can be used in both pterional and cranio-orbital craniotomies. METHODS The subperiosteum of the temporalis muscle is dissected sharply away from the temporal fossa preserving the deep temporal arteries and nerves. After the intracranial procedure, the bone flap is resecured and attached to the bone, and then several small holes are made along the superior temporal line, to which the temporalis muscle is directly reattached with sutures. RESULTS We have used the technique described in over 100 cases without related cosmetic or temporalis atrophy. With this technique, muscle tension has been maintained with good stabilization and cosmetic appearance. CONCLUSION In our technique, the temporalis muscle is anatomically reconstructed to the bone with easy attachment to the superior temporal line. The muscle tension is maintained with good stabilization and cosmetic appearance. (C) 1999 by Elsevier Science Inc.