Post-neurosurgical temporal deformities: Various techniques for correction and associated complications

Introduction: An irregular craniofacial contour along the temporal fossa, known commonly as "temporal hollowing deformity," (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity. Methods: Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented. Results: Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry. Conclusions: Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction.