Extended supramaximal decompressive craniectomy with temporalis muscle resection in traumatic brain injury

Introduction: Describe a surgical technique in cases of traumatic brain injury where the temporalis muscle causes a vector effect on brain structures and present a series of 8 characteristic cases. Material and Methods: A retrospective analysis was carried out on 8 patients who underwent decompressive craniectomy, in whom control tomographic studies revealed blood infiltration and inflammation of the temporalis muscle with compression on brain structures. A second intervention was performed in which the temporalis muscle was resected, presenting an improvement in the functional prognosis. Results: Three died from the initial trauma and intracranial hypertension refractory to medical management, five survived with moderate disability for life 3 months after surgery. Discussion: Decompressive craniectomy is a standard procedure involving the remotion of a sizeable frontotemporoparietal bone flap. However, external decompression based on the opening of the cranial vault can be limited by extradural structures, particularly the temporal muscle and its fascia. The original technical description has received some modifications, which some groups have suggested. Among these modifications, we can mention the addition of resection of the temporal muscle and its fascia. Conclusions: Supramaximal craniectomy with total or partial removal of the temporalis muscle may be useful in selected cases and a larger number of studies are required to determine whether it positively or negatively affects the prognosis in these patients.