Improved Outcomes With Temporalis Resuspension During Cranioplasty for Craniofacial Reconstruction After Decompressive Hemicraniectomy

BACKGROUND AND OBJECTIVES: Temporal hollowing is a well-documented and common phenomenon after decompressive hemicraniectomy and arises from the loss of temporalis muscle bulk due to muscle elevation, absence of underlying bone, and other alterations in soft tissue dynamics postsurgery. Temporalis muscle resuspension is a promising technique to minimize hollowing, and we present our technique for muscle resuspension during cranioplasty to minimize cosmetic and functional concerns. METHODS: We performed a retrospective single-center review of all patients diagnosed with frontotemporoparietal cranial defects after decompressive hemicraniectomy who underwent either cranioplasty only or cranioplasty in combination with temporalis muscle resuspension from January 2023 to January 2025. The Rostock Functional and Cosmetic Cranioplasty score was used to evaluate surgical outcomes. RESULTS: We analyzed 27 total patients, and of these, 15 patients underwent cranioplasty only and 12 underwent cranioplasty with temporalis muscle resuspension. The mean age for the cranioplasty only and cranioplasty with temporalis muscle resuspension groups was 42 ± 5 years and 43 ± 6 years, respectively, and mean follow-up was 523 ± 88 and 265 ± 31 days, respectively. Regarding Rostock Functional and Cosmetic Cranioplasty score, patients who underwent cranioplasty with temporalis muscle resuspension included a significantly higher proportion with a good score (4-6) in comparison with patients who underwent cranioplasty only (P < .01). CONCLUSION: In our cohort, the Rostock scores, evaluating cosmetic appearance, were better in the group in which we deployed our temporalis resuspension technique. By preserving the integrity of the temporalis muscle and resuspending it to the underlying cranial implant, we believe that this approach minimizes temporal hollowing and improves patient satisfaction and overall outcomes.