Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea.
Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea.
World Neurosurg. 2019 Jun;126:e1160-e1168. doi: 10.1016/j.wneu.2019.02.221. Epub 2019 Mar 14.
Temporalis muscle (TM) hollowing is a complication of cranioplasty which diminishes the aesthetical outcome of the surgery and results in suboptimal functional outcome. We present and compare a modified split-temporalis muscle elevated margin cranioplasty using 3-dimensional printed titanium implant with conventional 3-dimensional printed titanium implant cranioplasty to determine an effective treatment method.
A modified 3-dimensional printed cranial implant was designed where the anteroinferior border of the implant was extended and elevated between the frontozygomatic suture and root of zygomatic process. Furthermore, the implant was placed in between superficial and deep layers of the temporalis muscle. Aesthetical evaluation was carried out at the outpatient clinic, and a quantitative analysis showing the percentage difference in length of the operated and nonoperated sides was performed.
For both conventional and augmented groups, there were 0% major or minor complications. Out of 10 conventional cranioplasty patients, there were 3 cases of mild and 1 case of severe TM hollowing, whereas for 10 augmented cranioplasty patients, there was only 1 patient with mild TM hollowing. When a quantitative analysis was carried out, the overall percentage difference in length at the coronal view for conventional and augmented cranioplasty was -2.17% and 0.07%, respectively.
The augmented cranioplasty leads to superior aesthetical outcome, and the quantitative analysis also supports the efficacy of augmented cranioplasty. The surgery is technically simpler than the conventional method, therefore lowering the risk of surgical complications. Therefore, we hope that the modified cranioplasty method will be considered as an effected cranioplasty method for preventing TM hollowing.
颞肌（TM）凹陷是颅骨修补术的一种并发症，会降低手术的美观效果，并导致手术功能恢复不佳。我们提出并比较了一种改良的颞肌劈开抬高边缘颅骨修补术，使用 3D 打印钛植入物与传统的 3D 打印钛植入物颅骨修补术，以确定有效的治疗方法。
设计了一种改良的 3D 打印颅骨植入物，其中植入物的前下边界在额颧缝和颧骨根部之间延伸和抬高。此外，植入物放置在颞肌的浅层和深层之间。在门诊进行美容评估，并进行定量分析，显示手术侧和非手术侧长度的百分比差异。
对于传统组和改良组，均无严重或轻微并发症。在 10 例传统颅骨修补术患者中，有 3 例轻度 TM 凹陷，1 例重度 TM 凹陷，而在 10 例改良颅骨修补术患者中，只有 1 例轻度 TM 凹陷。进行定量分析时，传统和改良颅骨修补术冠状视图的总长度百分比差异分别为-2.17%和 0.07%。
改良颅骨修补术可获得更好的美观效果，定量分析也支持改良颅骨修补术的疗效。该手术技术比传统方法更简单，因此降低了手术并发症的风险。因此，我们希望改良的颅骨修补方法能被视为预防 TM 凹陷的有效颅骨修补方法。
