Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures

1998 ◽  
Vol 50 (4) ◽  
pp. 347-351 ◽  
Author(s):  
Takahito Miyazawa
Keyword(s):  
Temporalis Muscle ◽  
Pterional Craniotomy ◽  
Less Invasive

Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy

1996 ◽  
Vol 84 (2) ◽  
pp. 297-299 ◽  
Author(s):  
Susumu Oikawa ◽  
Masahiko Mizuno ◽  
Shinsuke Muraoka ◽  
Shigeaki Kobayashi
Keyword(s):  
Muscle Atrophy ◽  
Simple Technique ◽  
Temporalis Muscle ◽  
Content Type ◽  
Pterional Craniotomy ◽  
Less Invasive ◽  
Fine Print

✓ A procedure for preventing muscle atrophy in pterional craniotomy by temporalis muscle dissection is described, along with anatomical considerations. The inferior to superior dissection of the temporalis muscle is a very simple technique and is less invasive than other approaches.

scholarly journals Interdigitated craniotomy: a simple technique to fix a bone flap with only a single plate

2015 ◽  
Vol 123 (4) ◽  
pp. 1055-1058 ◽  
Author(s):  
Noboru Takahashi ◽  
Kazunori Fujiwara ◽  
Keiichi Saito ◽  
Teiji Tominaga
Keyword(s):  
Simple Technique ◽  
Plate Fixation ◽  
Bone Flap ◽  
Cranial Bone ◽  
Temporalis Muscle ◽  
Cosmetic Results ◽  
Pterional Craniotomy ◽  
Single Plate ◽  
Radiological Images ◽  
Cut Surface

In pterional craniotomy, fixation plates cause artifacts on postoperative radiological images; furthermore, they often disfigure the scalp in hairless areas. The authors describe a simple technique to fix a cranial bone flap with only a single plate underneath the temporalis muscle in an area with hair, rather than using a plate in a hairless area. The key to this technique is to cut the anterior site of the bone flap at alternate angles on the cut surface. Interdigitation between the bone flap and skull enables single-plate fixation in the area with hair, which reduces artifacts on postoperative radiological images and provides excellent postoperative cosmetic results.

Osteoplastic Pterional Craniotomy Revisited

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons125-ons129 ◽  
Author(s):  
Ealmaan Kim ◽  
Johnny B. Delashaw
Keyword(s):  
Computed Tomography ◽  
Muscle Function ◽  
Bone Flap ◽  
Temporalis Muscle ◽  
Pterional Approach ◽  
3 Dimensional ◽  
Pterional Craniotomy ◽  
Computed Tomography Scans ◽  
Brain Aneurysms ◽  
Additional Labor

Abstract BACKGROUND: A standard pterional approach with a free bone flap to treat brain aneurysms was first introduced and popularized by Yaşargil. OBJECTIVE: To describe a modified pterional craniotomy technique and that mobilizes part of the sphenoid wing and the pterion in a block with the temporalis muscle to enhance cosmetic results. METHODS: A subperiosteal corridor is provided inferiorly by separating the temporalis muscle from the underlying bone in a retrograde dissection. Inferior chisel cuts from the front and back enter the sphenoid wing, enabling removal of part of the sphenoid wing and the pterion in 1 piece, along with the bone flap. Forty patients with aneurysms were treated in this fashion, and the cosmetic outcome was examined at 6 months postoperatively. RESULTS: Thirty-seven patients (92.5%) demonstrated an unremarkable degree of temporalis muscle atrophy. Excellent configuration and fusion of the pterional bone flap were observed on 3-dimensional computed tomography scans. CONCLUSION: With the use of this muscle-preserving and bone-sparing pterional approach and with little additional labor, temporalis muscle function is preserved and improved cosmesis is obtained.

Frontozygomatic Titanium Cranioplasty in Frontosphenotemporal (“Pterional”) Craniotomy

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS262-ONS265 ◽  
Author(s):  
Shaan M. Raza ◽  
Quoc-Anh Thai ◽  
Gustavo Pradilla ◽  
Rafael J. Tamargo
Keyword(s):  
Vascular Malformations ◽  
Titanium Plate ◽  
Temporalis Muscle ◽  
Pterional Craniotomy ◽  
Orbital Pain ◽  
Definitive Solution ◽  
Cosmetic Outcomes ◽  
Common Problems ◽  
Titanium Cranioplasty

Abstract Objective: One of the most common problems after frontosphenotemporal, or pterional, craniotomy is the marked depression of the frontozygomatic fossa caused by atrophy of the temporalis muscle. Although temporalis muscle reconstruction techniques have been proposed to prevent this problem, a definitive solution has not been achieved. We report the results of a titanium cranioplasty technique in a prospective series of patients who underwent frontosphenotemporal craniotomy. Methods: Between April 2002 and June 2006, 209 consecutive patients underwent a frontosphenotemporal craniotomy for aneurysms, vascular malformations, or tumors. At the time of surgery, the patients underwent a frontozygomatic fossa cranioplasty with a titanium plate, to which the temporalis muscle was attached. In this series, 194 patients had documented follow-up periods averaging 9.5 months (range, 1 mo–4 yr; median, 7.5 mo), and the cosmetic results of the cranioplasty have been assessed. Results: The cosmetic outcomes have been outstanding in all patients treated to date. Two patients had the cranioplasty removed due to either orbital pain or local infection secondary to sepsis. Conclusion: The frontozygomatic cranioplasty during frontosphenotemporal craniotomy prevents the characteristic depression at the frontozygomatic fossa and accomplishes an outstanding cosmetic result.

Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy

1987 ◽  
Vol 67 (3) ◽  
pp. 463-466 ◽  
Author(s):  
M. Gazi Yaşargil ◽  
Mark V. Reichman ◽  
Stefan Kubik
Keyword(s):  
Facial Nerve ◽  
Temporalis Muscle ◽  
Content Type ◽  
Pterional Craniotomy ◽  
Fine Print

✓ The pterional craniotomy as described previously by the first author requires creation of a special flap over the temporalis muscle for increased visibility. Topographical variations of the course taken by the frontal branches of the facial nerve were studied and are described in this report.

The Minipterional Craniotomy for Anterior Circulation Aneurysms: Initial Experience With 72 Patients

2014 ◽  
Vol 10 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Justin M. Caplan ◽  
Kyriakos Papadimitriou ◽  
Wuyang Yang ◽  
Geoffrey P. Colby ◽  
Alexander L. Coon ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Average Length ◽  
Temporalis Muscle ◽  
Anterior Circulation ◽  
Pterional Craniotomy ◽  
Anterior Circulation Aneurysms

Abstract BACKGROUND: The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. OBJECTIVE: To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms. METHODS: From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap. RESULTS: The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average follow-up was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients. CONCLUSION: The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.

scholarly journals Cosmetic Reconstruction of Frontotemporal Depression Using Polyethylene Implant after Pterional Craniotomy

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Sang Hyuk Im ◽  
Jongkeun Song ◽  
Sang Kyu Park ◽  
Eun Young Rha ◽  
Young-Min Han
Keyword(s):  
Medical Records ◽  
Volume Ratio ◽  
Muscle Thickness ◽  
Muscle Volume ◽  
Thickness Ratio ◽  
Temporalis Muscle ◽  
Porous Polyethylene ◽  
Pterional Craniotomy ◽  
Affected Side ◽  
The Mean

Purpose. Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. The present study was performed to determine the postoperative outcomes of patients following frontotemporal depression reconstruction using a high-density porous polyethylene (HDPE) implant (Medpor®; Stryker, Kalamazoo, MI) after pterional craniotomy.Materials and Methods. The patients had undergone reconstruction of frontotemporal depression using Medpor® implants after pterional craniotomy at our medical institution during the period from February 2010 to March 2014. We evaluated the thickness and volume of both the temporalis muscle and Medpor® implant through a retrospective review of the medical records and computed tomography (CT) scans of 92 patients.Results. The mean temporalis muscle thickness ratio (muscle thickness of the affected side/nonaffected side) was 0.61 ± 0.16. The mean reconstructed temporalis muscle thickness ratio (muscle and Medpor® implant thickness of affected side/muscle thickness of nonaffected side) was 1.15 ± 0.02. The mean temporalis muscle volume ratio (muscle volume of affected side/nonaffected side) was 0.67 ± 0.02. The mean reconstructed temporalis muscle volume ratio (muscle and Medpor® implant volume of affected side/muscle volume of nonaffected side) was 1.18 ± 0.02.Conclusions. Temporalis muscle thickness and volume were significantly decreased on the affected side after pterional craniotomy. Reconstruction of frontotemporal lesions using Medpor® implants after the pterional approach improved temporal hollowing without additional complications.

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