Double dural patch in decompressive craniectomy to preserve the temporal muscle: technical note

In frontotemporal decompressive craniectomy and subsequent cranioplasty, temporal muscle damage is frequently observed as a result of surgical manipulation, lack of bone attachment, and prolonged muscle inactivity. We investigated the use of a double dural patch in decompressive craniectomy to favor the safe surgical dissection of the temporal muscle in the subsequent cranioplasty and reduce temporal muscle damage. In 11 patients submitted to a decompressive craniectomy and duraplasty, a second (external) dural sheet was positioned to separate the inner dural patch from the temporal muscle. When bone repositioning was performed, the detachment of the deep temporal muscle surface, covered by the external dural sheet, was easy and fast, with reduced blood loss. All the muscle fibers were preserved. The technique described in this article reduces the damage to the temporal muscle and can improve the functional and cosmetic results after decompressive craniectomy and cranioplasty.