American Journal of Clinical Neurology and Neurosurgery
Articles Information
American Journal of Clinical Neurology and Neurosurgery, Vol.3, No.1, Mar. 2018, Pub. Date: Sep. 4, 2018
Benefit of a Modified Muscle Pedunculated Pterional Craniotomy
Pages: 1-4 Views: 466 Downloads: 251
[01] Fumihiro Arai, Department of Neurosurgery, Sano Kosei General Hospital, Sano City, Tochigi, Japan.
[02] Mutsumi Nagai, Department of Neurosurgery, Sano Kosei General Hospital, Sano City, Tochigi, Japan.
The ugliness of face disproportion resulting from temporal muscle atrophy or facial nerve dysfunction is a major lasting sequela of pterional craniotomy. Now, two authors have presented promising methods to overcome the risk of facial disproportion by forming a pedunculated bone flap with the temporal muscle, however, their methods are somewhat complex and the efficacies of their methods have not been yet supported with predominance statistically yet. We modified the conventional method and developed an effective, easy alternative procedure to create a pedunculated bone flap, then evaluated the efficacy of it statistically. The following key modifications were applied: Make a curved line incision in the skin as usual and then cut the pericranium and temporal muscle along the skin incision. Dissect the subfascial space while elevating the temporal fascia, keeping it attached to the overlying scalp. Beneath the temporal muscle, create three small working spaces for an opening burr hole and a tunnel for bone cutting by dissecting a small portion of the temporal muscle from the bone surface. Remove the bone flap with the attached temporal muscle (pedunculated bone flap) and then inferoposteriorly reflect this flap. This procedure provides a wide operative field for the pterional approach. Records of 24 patients subjected to this method and 107 control patients in our centers were retrospectively reviewed. We assessed temporal muscle atrophy at two years following craniotomy by comparing the thickness of the temporal muscle of the operative side with its counterpart using CT or MRI imaging. Facial nerve dysfunction was also assessed in these patients. The ratio of the temporal muscle thickness of the operative side to its counterpart was 0.83 (median 0.84±0.12) in the new method group and 0.74 (median 0.75±0.18) in the control group. The temporal muscle atrophy rate was significantly reduced in the new method group (p=0.03). Facial nerve function was normal in all patients. The modified muscle pedunculated pterional craniotomy method developed herein is simple and easy in addition to providing a wide field for the pterional approach. The method prevents the future facial disproportion, which is supported by the statistical analysis.
Temproral Muscle Atrophy, Pterional Craniotomy, Facial Nerve Injury, Pedunculated Bone Flap, Temporal Muscle Thickness
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