Jackson Marcus, Karuparti Sasidhar, Nunna Ravi, Willson Thomas David, Rivera Arnaldo, Carr Steven B
Department of Neurosurgery, University of Missouri School of Medicine, Columbia, United States.
Department of Surgery, Division of Plastic Surgery, University of Missouri School of Medicine, Columbia, United States.
Surg Neurol Int. 2025 May 2;16:159. doi: 10.25259/SNI_996_2024. eCollection 2025.
Temporalis muscle (TM) atrophy is a commonly encountered cosmesis issue following craniotomies. This retrospective study aims to investigate the correlation of clinical and surgical factors with postoperative TM volume and head symmetry in patients undergoing frontotemporal craniotomy.
Medical records were retrospectively reviewed for patients undergoing pterional or middle fossa craniotomy. Pre- and post-operative clinical factors, intraoperative factors, and magnetic resonance imaging magnetic resonance imaging scans were obtained. TM volumes (cm) were measured using volumetric analysis. 3-D reconstructed images of the head were independently reviewed to grade head symmetry on a binary scale. Pairwise correlation matrix, multiple linear regression (MLR), and logistic regression (LR) were used to assess the relationship of clinical and operative factors with TM volume and head symmetry.
A total of 46 patients were included for analysis, including pterional ( = 27) and middle fossa ( = 19) groups. The average TM volume loss was 36.8% (standard deviation [Std]: 17.18%) and 29.5% (Std: 16.72%) for patients receiving pterional and middle fossa craniotomies, respectively, indicating the pterional approach may carry a greater risk of disrupting the TM neurovascular supply ensuing subsequent cosmetic disfigurement. MLR identified age and scalp thickness as predictors of TM volume ( < 0.05). Age and scalp thickness were also the only factors found to be predictors of head asymmetry ( < 0.01).
Pterional and middle fossa craniotomy procedures are both associated with significant TM volume loss and subsequent head asymmetry. Age and preoperative scalp thickness are independent risk factors for the development of TM volume loss and head asymmetry. These findings could contribute to the development of preoperative risk stratification algorithms, enabling neurosurgeons to predict the likelihood of cosmetic disfigurement. This would enhance preoperative counseling for patients undergoing craniotomy procedures, especially for elderly individuals and those with thin scalps. Overall, this study provides valuable insights into prognostic factors that may impact the development of poor cosmesis following frontotemporal craniotomy.
颞肌萎缩是开颅术后常见的美容问题。本回顾性研究旨在探讨接受额颞部开颅手术患者的临床和手术因素与术后颞肌体积及头部对称性的相关性。
回顾性分析接受翼点或中颅窝开颅手术患者的病历。获取术前和术后的临床因素、术中因素以及磁共振成像扫描结果。使用容积分析测量颞肌体积（立方厘米）。对头部的三维重建图像进行独立评估，以二元尺度对头部对称性进行分级。使用成对相关矩阵、多元线性回归（MLR）和逻辑回归（LR）来评估临床和手术因素与颞肌体积及头部对称性的关系。
共纳入46例患者进行分析，包括翼点组（n = 27）和中颅窝组（n = 19）。接受翼点和中颅窝开颅手术的患者，颞肌平均体积损失分别为36.8%（标准差 [Std]：17.18%）和29.5%（Std：16.72%），这表明翼点入路可能有更大风险破坏颞肌神经血管供应，进而导致后续美容缺陷。多元线性回归确定年龄和头皮厚度为颞肌体积的预测因素（P < 0.05）。年龄和头皮厚度也是发现的仅有的头部不对称预测因素（P < 0.01）。
翼点和中颅窝开颅手术均与显著的颞肌体积损失及随后的头部不对称相关。年龄和术前头皮厚度是颞肌体积损失和头部不对称发生的独立危险因素。这些发现有助于制定术前风险分层算法，使神经外科医生能够预测美容缺陷的可能性。这将加强对接受开颅手术患者的术前咨询，尤其是对老年患者和头皮薄的患者。总体而言，本研究为可能影响额颞部开颅术后美容效果不佳的预后因素提供了有价值的见解。
