Objectives: Brain lesion treatment by craniotomy approach is commonly used in treating patients with benign brain tumor or vascular lesions. However, in some cases, post-craniotomy can cause temporal soft tissue hollowing, which cause patients’ numbness, tightness or unacceptable appearance. We presented this method in the management of these patients in Taipei Veteran General Hospital during the last three years.
Materials and Methods: From 2018-2020, 11 patients received craniotomy as treatment for meningioma (6 patients, 54.5%), aneurysm (4 patients, 36.4%) and trigeminal neuralgia (1 patient, 9.1%). All patients received liposuction from lower abdomen with immediate autologous fat graft and serial cryopreserved fat graft as treatment for temporal soft tissue hollowing.
Results: In these 11 patients, 1 was male and 10 were female. The average age was 53.41-year-old. The average BMI was 22.36. There was one patient with hypertension and one patient with diabetes mellitus (not the same patient). The average neurosurgery lesion size was 4.75mm for aneurysm and 25.67mm for meningioma. The lesion sites distributed near the same with 6 over right side and 5 over left side. All patient received pre-temporal craniotomy except the trigeminal neuralgia patient received retro-sigmoid incision. No patient received radiotherapy due to all benign lesions noted. The average interval before receiving autologous fat graft injection was 425.0 days. All patient received liposuction via lower abdomen with the average amount of harvested fat was 49.6ml. No peri-operative infection was noted in these patients. The mean injection volume was 6.45ml over the lesion site during the first visit. Serial treatment may take place with average injection times were 3.8 times in this study. Before and after the treatment, patient received questionnaire survey, which showed mental-related problems score improved from 11 to 20.5 (7 questions, 1 to 4 score each, 1 present the worst and 4 present the best outcome). Also, symptom-related problems score improved from 9.9 to 13.6 (5 questions, 1 to 4 score each, 1 present the worst and 4 present the best outcome). All hollowing showed improvement to some degree after treatment by comparing the peri-operative photographs. The mean follow-up time was 24.4 months (ranging from 8.37 to 38.47).
Conclusion: Autologous fat graft injection is a safe and feasible surgery in treating patients with post-craniotomy temporal soft tissue hollowing with acceptable outcome.

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