The Importance of Approach Direction During Cranioplasty: Differences in Clinical and Surgical Outcomes by Surgical Approach

Objective: This study evaluated the effectiveness of changing the surgical approach direction to enable rapid and accurate identification of the surgical plane, thereby allowing relatively intact separation of the temporalis muscle from the epidural space without dural injury.Outcomes were compared between this method and other surgical approaches.Methods: A total of 90 patients who met the inclusion criteria and underwent cranioplasty were included in the study.The patients were divided into a temporal approach group and a frontal approach group.Demographic characteristics and surgical, clinical, and functional outcomes were collected for all patients and compared between the two groups.Results: Among the 90 patients, 24 were assigned to Group 1 and 66 to Group 2. No statistically significant differences in demographic variables were observed between the two groups.Among surgery-related factors, operative time was shorter in Group 1 than in Group 2; specifically, operative time was more than 21 minutes longer in Group 2 than in Group 1 (p=0.01).Regarding postoperative pain, the visual analogue scale score was temporarily lower in Group 1 than in Group 2 on postoperative day 5 (p=0.03),but no statistically significant difference was observed after 2 weeks.Although masticatory impairment was more frequent in Group 2, the between-group difference was not statistically significant.Conclusion: This study examined the utility of approach direction during cranioplasty.Although the temporal approach was associated with reduced operative time, it did not significantly affect postoperative pain or functional outcomes.