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  • Management of post-decompressive craniectomy intracranial hypertension caused by intramural hematoma of temporal muscle

    Final Number:

    Lu-Ting Kuo MD PhD; Shih-Hao Huang; Sheng-Jean Huang

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Decompressive craniectomy has been used effectively to treat traumatic brain swelling in recent years. However, we observed an uncommon complication of decompressive craniectomy.

    Methods: In this study, we retrospectively reviewed the records of 168 patients admitted with severe head injury from Jan. 1997 to Dec. 2009. Eight patients developed intractable increased intracranial pressure within one day after craniectomy due to intramural hemorrhage of the temporal muscle, which was confirmed by CT scans. All patients were treated by resection of the muscle.

    Results: The initial Glasgow Coma Scale score was 7.42±0.78. The mean intracranial pressure (ICP) was 41.7 ± 8.59 mmHg before resection of the muscle and 14.81 ± 8.07 mmHg immediately after the surgery. Their mean intensive care unit stay was 11.25 ± 5.99 days. On the basis of Extended Glasgow Outcome Scale scoring, 6 patients (75%) had a favorable outcome at their 12–month follow-up.

    Conclusions: To our knowledge, this is the first study to report on the long-term outcome of patients treated by resection of the temporal muscle after craniectomy. We find that resection of the muscle can control ICP and results in favorable outcome and fair masticatory function.

    Patient Care: This is the first study to evaluate the long-term outcome of patients treated by temporal muscle resection after craniectomy.

    Learning Objectives: Intramural hematoma of temporal muscle should be considered in patients with elevated intracranial pressure after decompressive craniectomy. Better control of intracranial pressure with favorable long-term outcome and serviceable masticatory function can be reached by excision of the termporal muscle.


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