Reduced Temporal Muscle Thickness Is Associated with Increased Postoperative Complications After Cranioplasty

Background/Objectives: Cranioplasty is a common reconstructive procedure following decompressive craniectomy, yet postoperative complications requiring reoperation remain frequent. Sarcopenia has been associated with adverse surgical outcomes. Temporalis muscle thickness (TMT), readily assessed on routine cranial CT, has been proposed as a surrogate marker of sarcopenia; however, its role in predicting cranioplasty outcomes remains to be established. This study aimed to evaluate the association between TMT and postoperative complications requiring reoperation after cranioplasty. Methods: In this retrospective single-center cohort study, 71 patients undergoing cranioplasty after decompressive craniectomy were included. Patients were stratified according to the occurrence of postoperative complications requiring reoperation into a complication group (n = 28) and an uneventful postoperative course group (n = 43). TMT was measured on preoperative CT scans obtained prior to craniectomy and prior to cranioplasty. Reduced TMT was defined as ≤5 mm. Results: Postoperative complications requiring surgical revision occurred in 39.4% of patients. Reduced TMT (≤5 mm) was significantly associated with greater reoperation risk in univariate analysis (p = 0.003). Patients undergoing surgical revision had significantly lower TMT prior to craniectomy (4.6 mm vs. 5.3 mm; p = 0.03) and TMT remained an independent predictor in multivariate analysis. Conclusions: Reduced TMT is independently associated with an increased risk of postoperative complications after cranioplasty requiring surgical revision and may serve as a simple imaging-based marker for preoperative risk stratification.