Technical approaches for preservation of the temporalis muscle in neurosurgery: a systematic review

The temporalis muscle is commonly dissected and mobilized during craniotomy. Cosmetic and functional complications may arise from the improper handling of this muscle. Surgery for recurrent pathologies may be challenging due to adhesions and muscle damage.

A systematic review following PRISMA guidelines was conducted to consolidate literature on the potential techniques used for preserving the temporalis muscle during neurosurgical interventions. PubMed, Scopus, and Web of Science were systematically searched using predefined criteria from inception to 2025. A qualitative synthesis was done summarizing the primary cranial pathology, type of surgical approach, the technical clue for temporalis muscle preservation, follow up and complications.

We included 27 eligible articles with a total number of 811 patients. About 508 (62.6%) of patients underwent pterional approach, while 150 (18.4%) patients had decompressive craniotomies. Aneurysm clipping was the surgical indication in 172 (21.2%) patients, while decompressive surgery was done for traumatic brain injuries in about 48 (5.9%) patients. Osteoplastic temporalis muscle flap was used in 178 (21.9%) patients, while some authors sutured the temporalis muscle to the cranioplasty plate in 79 (9.7%) patients. Fixation of the temporalis muscle to the bone using sutures through small holes was done in 100 (12.33%) patients. No chewing problems were recorded among all the patients analyzed. Temporalis muscle atrophy was observed in only 13 (1.6%) patients.

Proper manipulation of the temporalis muscle during surgery is crucial for the vitality of its fibers and to prevent postoperative functional or cosmetic drawbacks.