Dr. Mohana Rao.
Invited faculty neurosurgeon highlights the importance of temporalis muscle resuspension during cranioplasty to improve long-term reconstructive outcomes after severe traumatic brain injury.
As advances in neurocritical care and emergency neurosurgery continue to improve survival after severe traumatic brain injury (TBI), attention is increasingly shifting toward the long-term reconstructive challenges faced by survivors. One such challenge is temporal hollowing-a common postoperative deformity that develops after decompressive hemicraniectomy and can affect facial symmetry, temporalis muscle function and overall quality of life.
At NeuroTrauma 2026, the annual scientific conference of the Neurotrauma Society of India (NTSI) held in Hyderabad from 7-9 August 2026, Dr. Mohana Rao Patibandla participated as invited faculty and presented his scientific talk titled "Prevention of Temporal Hollowing Following Trauma-Related Decompressive Hemicraniectomy Using Temporalis Muscle Resuspension During Cranioplasty." The conference brought together leading neurosurgeons, neurotrauma specialists and researchers from across India to discuss contemporary advances in traumatic brain and spinal injury management.
Dr. Rao's presentation focused on an anatomical reconstruction strategy designed to preserve the normal position and contour of the temporalis muscle during cranioplasty, with the aim of preventing temporal hollowing before it develops rather than correcting it after surgery.
Looking Beyond Survival in Neurotrauma
Decompressive hemicraniectomy is a life-saving procedure performed in selected patients with severe traumatic brain injury when swelling inside the skull becomes life-threatening. By temporarily removing part of the skull, surgeons create space for the swollen brain, reducing intracranial pressure and preventing further neurological injury.
Once the brain swelling resolves, cranioplasty is performed to reconstruct the skull defect and restore cranial protection. Although this second-stage surgery restores the skull, many patients experience gradual loss of fullness over the temple due to changes in the temporalis muscle and surrounding soft tissues.
As survival rates improve, reconstructive outcomes have become an increasingly important part of comprehensive neurotrauma care.
Understanding Temporal Hollowing
Temporal hollowing is characterised by a visible depression in the temporal region of the head following decompressive craniectomy and cranioplasty. The deformity typically results from displacement, atrophy or inadequate restoration of the temporalis muscle during reconstruction.
While often considered a cosmetic concern, temporal hollowing has important functional implications. The temporalis muscle is one of the primary muscles involved in mastication and contributes significantly to facial contour and symmetry. Inadequate reconstruction can therefore influence chewing mechanics, facial appearance and patient confidence during recovery.
The condition may become particularly noticeable in younger patients and in individuals recovering from major traumatic brain injuries who survive with otherwise good neurological outcomes.
Prevention Rather Than Correction
A central message of Dr. Rao's invited faculty lecture was that temporal hollowing should be addressed during cranioplasty, rather than treated as a secondary reconstructive problem months later.
The technique presented at NTSI 2026 involves temporalis muscle resuspension, an anatomical reconstruction strategy intended to restore the muscle to its physiological position and maintain its natural tension during skull reconstruction.
The presentation discussed principles of muscle preservation, anatomical fixation and reconstruction aimed at maintaining temporal contour while preserving muscle function.
"Neurotrauma surgery should not end with saving a life. Reconstruction should also aim to restore anatomy, function and quality of life wherever possible." - Dr. Rao
Why Temporalis Muscle Resuspension Matters
The temporalis muscle undergoes significant manipulation during decompressive hemicraniectomy. Without meticulous reconstruction during cranioplasty, the muscle may retract, scar or lose its anatomical alignment, contributing to postoperative hollowing.
Dr. Rao's presentation highlighted how careful muscle resuspension during reconstruction may help preserve both the contour of the temporal region and the functional anatomy of the muscle.
The emphasis was on anatomical restoration as an integral part of modern cranial reconstruction rather than an isolated cosmetic procedure.
A Changing Perspective in Neurotrauma Surgery
Neurotrauma surgery has traditionally focused on rapid intervention to prevent mortality and permanent neurological injury. However, improvements in trauma systems, neurocritical care and rehabilitation have increased the number of patients recovering from severe traumatic brain injury.
This evolution has expanded the goals of treatment beyond survival to include neurological recovery, facial symmetry, mastication, rehabilitation and overall quality of life.
Reconstructive planning during cranioplasty has therefore become an important component of long-term neurotrauma management, particularly in younger patients expected to return to education, work and daily life.
NTSI 2026 Highlights Advances in Traumatic Brain Injury Care
NeuroTrauma 2026 served as the flagship annual academic meeting of the Neurotrauma Society of India, featuring scientific sessions on traumatic brain injury, spinal trauma, neurocritical care, cranial reconstruction, minimally invasive neurotrauma surgery and rehabilitation. The conference emphasised evidence-based innovations aimed at improving both acute management and long-term recovery after neurotrauma.
Dr. Rao's invited faculty presentation contributed to this discussion by highlighting a preventive reconstructive strategy for one of the most frequently encountered long-term sequelae following decompressive hemicraniectomy.
Why This Surgical Discussion Matters
Temporal hollowing is increasingly recognised as more than a cosmetic deformity. As patients survive severe traumatic brain injury in greater numbers, preserving facial contour, muscle function and overall quality of life has become an important objective of reconstructive neurosurgery.
Dr. Rao's presentation reinforced a broader principle in contemporary neurotrauma care: successful surgery involves not only relieving life-threatening brain swelling but also restoring normal anatomy wherever possible during recovery.
About Dr. Rao
Dr. Mohana Rao Patibandla is a neurosurgeon and founder of Dr. Rao's Hospital - International Institute of Neurosciences (IIN) in Guntur, Andhra Pradesh. He has fellowship and international training in epilepsy surgery, pediatric neurosurgery, minimally invasive neurosurgery, skull base surgery, neuro-oncology, functional and stereotactic neurosurgery, and cerebrovascular and endovascular neurosurgery, and has received the Brainlab Neurosurgery Award from the Congress of Neurological Surgeons (CNS) and the Gold Medal at PASMISS-MISSABCON-COSS 2026 for his academic contributions to minimally invasive neurosurgery and spine surgery. Dr. Rao's clinical practice focuses on complex brain, spine, pediatric, epilepsy, cerebrovascular, skull base and minimally invasive neurosurgery, and he regularly serves as invited faculty at national and international scientific conferences.
Editor's Note: This article reports on a scientific invited faculty presentation delivered at NeuroTrauma 2026, the annual conference of the Neurotrauma Society of India. The surgical strategy discussed is intended for appropriately selected patients undergoing cranioplasty after decompressive hemicraniectomy, with treatment decisions based on individual anatomy, injury pattern and surgical judgment.
