Effects of Modified Osteoplastic Pterional Craniotomy on Temporal Muscle Volume and Frontal Muscle Nerve Function

2021 ◽  
Author(s):  
Mehmet Seçer ◽  
İsa Çam ◽  
Aykut Gökbel ◽  
Murat Ulutaş ◽  
Özgür Çakır ◽  
...  
Keyword(s):  
Skull Base Surgery ◽  
Nerve Damage ◽  
Muscle Volume ◽  
Bone Flap ◽  
Nerve Function ◽  
Temporal Muscle ◽  
Pterional Craniotomy ◽  
Temporomandibular Joint Pain ◽  
Muscle Nerve ◽  
Functional Problems

Abstract Introduction Pterional craniotomy is a surgical approach frequently used in aneurysm and skull base surgery. Pterional craniotomy may lead to cosmetic and functional problems, such as eyebrow drop due to facial nerve frontal branch damage, temporal muscle atrophy, and temporomandibular joint pain. The aim was to compare the postoperative effects of our modified osteoplastic craniotomy with classical pterional craniotomy in terms of any change in volume of temporal muscle and in the degree of frontal muscle nerve damage. Materials and Methods Aneurysm cases were operated with either modified osteoplastic pterional craniotomy or free bone flap pterional craniotomy according to the surgeon's preference. Outcomes were compared in terms of temporal muscle volume and frontal muscle nerve function 6 months postoperatively. Results Preoperative temporal muscle volume in the modified osteoplastic pterional and free bone flap pterional craniotomy groups were not different (p > 0.05). However, significantly less atrophy was observed in the postoperative temporal muscle volume of the osteoplastic group compared with the classical craniotomy group (p < 0.001). In addition, when comparing frontal muscle nerve function there was less nerve damage in the modified osteoplastic pterional craniotomy group compared with the classical craniotomy group, although this did not reach significance (p > 0.05). Conclusion Modified osteoplastic pterional craniotomy significantly reduced atrophy of temporal muscle and caused proportionally less frontal muscle nerve damage compared with pterional craniotomy, although this latter outcome was not significant. These findings suggest that osteoplastic craniotomy may be a more advantageous intervention in cosmetic and functional terms compared with classical pterional craniotomy.

Cosmetic and functional reconstruction achieved using a split myofascial bone flap for pterional craniotomy

2001 ◽  
Vol 94 (4) ◽  
pp. 667-670 ◽  
Author(s):  
Katsumi Matsumoto ◽  
Katsuhito Akagi ◽  
Makoto Abekura ◽  
Motohisa Ohkawa ◽  
Osamu Tasaki ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Muscle Flap ◽  
Functional Results ◽  
Bone Flap ◽  
Operative Field ◽  
Temporal Muscle ◽  
Content Type ◽  
Functional Reconstruction ◽  
Pterional Craniotomy ◽  
Fine Print

✓ Cosmetic deformities that appear following pterional craniotomy are usually caused by temporal muscle atrophy, injury to the frontotemporal branch of the facial nerve, or bone pits in the craniotomy line. To resolve these problems during pterional craniotomy, an alternative method was developed in which a split myofascial bone flap and a free bone flap are used. The authors have used this method in the treatment of 40 patients over the last 3 years. Excellent cosmetic and functional results have been obtained. This method can provide wide exposure similar to that achieved using Yaşargil's interfascial pterional craniotomy, without limiting the operative field with a bulky temporal muscle flap.

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.

scholarly journals Esthetics outcomes in patients submitted to pterional craniotomy and its variants: A scoping review

2021 ◽  
Vol 12 ◽  
pp. 461
Author(s):  
Daniel Buzaglo Gonçalves ◽  
Maria Izabel Andrade dos Santos ◽  
Lucas de Cristo Rojas Cabral ◽  
Louise Makarem Oliveira ◽  
Gabriela Campos da Silva Coutinho ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Patient Satisfaction ◽  
Muscle Atrophy ◽  
Randomized Clinical Trials ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Temporal Muscle ◽  
Pterional Craniotomy ◽  
Main Complaint ◽  
Evidence Level

Background: Highly performed nowadays, the pterional craniotomy (PC) has several widespread variants. However, these procedures are associated with complications such as temporalis muscle atrophy, facial nerve frontal branch damage, and masticatory difficulties. The postoperative cranial aesthetic is, nonetheless, the main setback according to patients. This review aims to map different pterional approaches focusing on final aesthetics. Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies were classified through the Oxford method. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library from January 1969 to February 2021 for cohorts and randomized clinical trials that met our inclusion criteria. Results: 1484 articles were initially retrieved from the databases. 1328 articles did not fit the inclusion criteria. 118 duplicates were found. 38 studies were found eligible for the established criteria. 27 (71.05%) were retrospective cohorts, with low evidence level. Only 5 (13.15%) clinical trials were found eligible to the criteria. The majority of the studies (36/38) had the 2B OXFORD evidence level. A limited number of studies addressed cosmetic outcomes and patient satisfaction. The temporal muscle atrophy or temporal hollowing seems to be the patient’s main complaint. Only 17 (44.73%) studies addressed patient satisfaction regarding the aesthetics, and only 10 (26.31%) of the studies reported the cosmetic outcome as a primary outcome. Nevertheless, minimally invasive approaches appear to overcome most cosmetic complaints and should be performed whenever possible. Conclusion: There are several variants of the classic PC. The esthetic outcomes are poorly evaluated. The majority of the studies were low evidence articles.

Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection

1997 ◽  
Vol 87 (4) ◽  
pp. 535-543 ◽  
Author(s):  
Chandranath Sen ◽  
Karin Hague
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Complete Resection ◽  
Nerve Function ◽  
Content Type ◽  
Factors Affecting ◽  
Cranial Nerve Function ◽  
Histological Factors ◽  
Fine Print

✓ Despite advances in the surgical treatment of meningiomas located at the skull base, surgery for meningiomas involving the cavernous sinus remains controversial. The controversy centers on whether complete resection of such a meningioma is possible while preserving cranial nerve function. To evaluate this question, the authors examined six patients with benign meningiomas involving the cavernous sinus. The pathological features of these tumors were evaluated and compared with the normal histoarchitecture of the cavernous sinus. The tendency of these tumors to be infiltrative is evident and this seems to occur along connective tissue planes within the cavernous sinus. This invasiveness can be explained by the peculiar structure of this region. The trigeminal nerve and ganglion seem to be particularly prone to invasion; this does not correlate with the degree of preoperative impairment of nerve function. Internal carotid artery invasion occurs frequently and can be seen even when there is no narrowing of the artery on arteriography. The pituitary gland can also be invaded by the tumor, which penetrates the thin dural barrier.

Technical nuances of temporal muscle dissection and reconstruction for the pterional keyhole craniotomy

2013 ◽  
Vol 118 (2) ◽  
pp. 309-314 ◽  
Author(s):  
Nancy McLaughlin ◽  
Aaron Cutler ◽  
Neil A. Martin
Keyword(s):  
Sylvian Fissure ◽  
Bone Flap ◽  
Anatomical Reconstruction ◽  
Muscle Flaps ◽  
Temporal Muscle ◽  
Cosmetic Results ◽  
Temporal Arteries ◽  
Temporal Fascia ◽  
Keyhole Craniotomy ◽  
Superficial Temporal Fascia

The supraorbital keyhole approach offers a limited access for aneurysms located at the middle cerebral artery (MCA) bifurcation with long M1 segments or proximal M2 aneurysms. Alternative minimally invasive routes centered on the pterion have been developed to address these aneurysms. Appropriate dissection and reconstruction of the temporal muscle are important for optimal exposure and best cosmetic results with the pterional keyhole craniotomy. The authors describe the technical nuances of temporal muscle dissection and reconstruction adapted to the pterional keyhole craniotomy. After incising the scalp in a curvilinear fashion behind the hairline, an interfascial dissection is performed, allowing anterior reflection of the superficial temporal fat pat and superficial temporal fascia. The temporal muscle is incised 7–10 mm below its insertion at the superior temporal line. The deep temporal fascia and temporal muscle are incised vertically, completing a T-shaped incision. Subperiosteal dissection of both muscle flaps preserves the deep temporal arteries and nerves. A craniotomy measuring 2.5–3 cm in diameter, based anteriorly at the pterion, is made over the sylvian fissure. Dissection of the sylvian fissure and of MCA aneurysms can proceed without the use of retractors. The bone flap and associated hardware is entirely covered by the temporal muscle, which is reconstructed in 2 layers: the temporal muscle/deep temporal fascia and the superficial temporal fascia. This dissection technique prevents damage to branches of the facial nerve and minimizes temporal muscle damage. Dividing the temporal muscle vertically and reflecting both parts anteriorly and posteriorly prevents suboptimal illumination and visualization under the microscope. Covering the bone flap and related hardware with a multilayer anatomical reconstruction optimizes cosmetic results.

scholarly journals Standard values for temporal muscle thickness in the Japanese population who undergo brain check-up by magnetic resonance imaging

2021 ◽  
Vol 12 ◽  
pp. 67
Author(s):  
Masahito Katsuki ◽  
Norio Narita ◽  
Keisuke Sasaki ◽  
Yoshimichi Sato ◽  
Yasuhiro Suzuki ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Skeletal Muscle ◽  
Magnetic Resonance ◽  
Muscle Mass ◽  
Reference Values ◽  
Muscle Thickness ◽  
Muscle Volume ◽  
Resonance Imaging ◽  
Temporal Muscle ◽  
Brain Check

Background: Skeletal muscle mass is an important factor for various diseases’ outcomes. The psoas muscle cross-sectional area on the abdominal computed tomography (CT), gait speed, and handgrip strength is used to measure it. However, it is difficult to measure the neurological patients’ muscle mass or function because (1) we do not perform abdominal CT. (2) Such patients have impaired consciousness, gait disturbance, paresis, and need of rest. Temporal muscle thickness (TMT) on magnetic resonance imaging (MRI) is now attractive for skeletal muscle volume indicator, but the reference values are not established. We herein investigated the standard value of the Japanese TMT using the brain check-up database by MRI. Methods: We retrospectively investigated 360 Japanese individuals from two institutions between 2017 and 2019. We measured TMT on the T1-weighted images in the previously reported way. The associations between TMT and other variables were analyzed. Results: TMT of 214 women and 146 men, ranging from 35 to 84 years old, was investigated. TMT ranged from 3.69 to 16.90 mm. Mean TMT values were significantly higher in men compared to women except for the over 70-year-old cohort. TMT was correlated to weight and body mass index in both sexes. Conclusion: This is the first retrospective study on the standard TMT values from the Japanese brain check-up database. Our results were just reference values, but these would be useful for further investigation in other neurosurgical and neurological diseases regarding muscle volume or sarcopenia.

Intraoperative electrooculographic monitoring of oculomotor nerve function during skull base surgery

1999 ◽  
Vol 91 (1) ◽  
pp. 157-159 ◽  
Author(s):  
Chikashi Fukaya ◽  
Yoichi Katayama ◽  
Masahiko Kasai ◽  
Jun Kurihara ◽  
Takamitsu Yamamoto
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Oculomotor Nerve ◽  
Nerve Function ◽  
Reliable Technique ◽  
Content Type ◽  
Surface Electrodes ◽  
Present Technique ◽  
And Function ◽  
Oculomotor Nerves

✓ Intraoperative monitoring techniques for protecting the integrity of the oculomotor nerves during skull base surgery have been reported by several investigators, all of which involved the use of electromyographic responses to extraocular muscles. However, these techniques have not yet become popular because of the complexity of the procedures. The authors report an extremely simple and far more reliable technique in which electrooculographic (EOG) monitoring is used. The oculomotor nerves were stimulated with a monopolar electrode during skull base exposure. The polarity of the EOG responses recorded with surface electrodes placed on the skin around the eyeball yielded precise information concerning the location and function of the oculomotor and abducent nerves. In addition, with the aid of continuous EOG monitoring that detected transient changes in the background waves, surgical procedures that might impinge on oculomotor nerve function could be avoided. The present technique has been used in eight patients with skull base tumors and with it, the authors have achieved excellent results.

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