Reconstruction of the temporalis muscle for the pterional craniotomy

1990 ◽  
Vol 73 (4) ◽  
pp. 636-637 ◽  
Author(s):  
Robert F. Spetzler ◽  
K. Stuart Lee
Keyword(s):  
Bone Flap ◽  
Temporalis Muscle ◽  
Content Type ◽  
Pterional Craniotomy ◽  
Fine Print

✓ Several techniques have been employed to incise the temporalis muscle for the pterional craniotomy. The authors describe a method which provides the advantage of a free bone flap, yet allows anatomical reapproximation of the temporalis muscle to its bone attachment.

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.

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.

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.

Modified osteoplastic orbitozygomatic craniotomy

2005 ◽  
Vol 102 (5) ◽  
pp. 940-944 ◽  
Author(s):  
Vijayabalan Balasingam ◽  
Akio Noguchi ◽  
Sean O. McMenomey ◽  
Johnny B. Delashaw
Keyword(s):  
Surgical Technique ◽  
Muscle Atrophy ◽  
Bone Infection ◽  
Bone Flap ◽  
Temporalis Muscle ◽  
Content Type ◽  
Orbital Rim ◽  
Supraorbital Foramen ◽  
Fine Print

✓ The authors report on a surgical technique involving a one-piece osteoplastic bone flap, which incorporates the frontal, temporal, and lateral portions of the orbital rim as a technically simpler alternative to the standard orbitozygomatic (OZ) craniotomy. The orbital rim component extends just laterally from the supraorbital foramen/notch to the frontozygomatic suture. This craniotomy obviates the need for removing the zygoma and has evolved from the authors' experience in more than 200 patients with a variety of pathological lesions, both vascular and tumorous. The osteoplastic aspect of this technique was initially evaluated in 14 cadaveric sites in seven heads dissected prior to implementing this procedure clinically. The osteoplastic bone flap minimally obstructs the surgical view and provides all the advantages of a standard OZ craniotomy. Temporalis muscle atrophy leading to temporal hollowing is avoided, a bone union to the calvaria is improved, and the possibility of bone infection is decreased. The osteoplastic component of the technique adds to the improved long-term cosmesis and warrants active consideration in the art of neurosurgery.

Titanium miniplates or stainless steel wire for cranial fixation: a prospective randomized comparison

2002 ◽  
Vol 96 (2) ◽  
pp. 244-247 ◽  
Author(s):  
William C. Broaddus ◽  
Kathryn L. Holloway ◽  
Charles J. Winters ◽  
M. Ross Bullock ◽  
R. Scott Graham ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Steel Wire ◽  
Stainless Steel Wire ◽  
Bone Flap ◽  
Content Type ◽  
Wire Fixation ◽  
Time Required ◽  
Titanium Miniplate ◽  
To Receive ◽  
Fine Print

Object. The authors designed a study to compare low-profile titanium miniplate fixation to that in which stainless steel wire is used. Methods. Before undergoing craniotomy, 40 patients gave informed consent and were randomized to receive either wire or miniplate fixation. After dural closure, bone flap fixation was timed. The bone flap was measured for inward or outward offset and mobility to manual pressure on its margin. Three months postoperatively the bone flap margins were graded for appearance or palpation of an offset and for the presence of burr hole depressions. Twenty-four patients were randomized to receive miniplate fixation and 16 to receive stainless steel wire fixation. The time required for wire fixation was approximately 40% longer than that for miniplates (11.8 ± 5.1 minutes compared with 8.3 ± 5 minutes, p = 0.02). The offset of bone flaps after wire fixation was significantly greater than that with miniplates (1.6 ± 1 mm compared with 0.3 ± 0.6 mm, p < 0.001), as was the mobility of the bone flap on digital pressure (1.2 ± 0.9 mm compared with 0.2 ± 0.5 mm, p < 0.001). At the 3-month follow-up review, two of 12 patients had suboptimal results after wire fixation, whereas none of 14 patients had suboptimal results after miniplate fixation. When dichotomized for excellent or less-than-excellent postoperative results, the data were significantly better for patients who underwent miniplate fixation (p < 0.05). Conclusions. Titanium miniplate cranial fixation provides more accurate and rigid reapproximation of the bone edges, with results that are significantly better on close inspection or palpation. The additional cost of miniplate fixation may thus be justified in many cases.

Hyperacute measurement of intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, and laser Doppler flowmetry, before and during removal of traumatic acute subdural hematoma

2001 ◽  
Vol 95 (4) ◽  
pp. 569-572 ◽  
Author(s):  
Bon H. Verweij ◽  
J. Paul Muizelaar ◽  
Federico C. Vinas
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Laser Doppler ◽  
Bone Flap ◽  
Acute Subdural Hematoma ◽  
Laser Doppler Flow ◽  
Content Type ◽  
Venous Oxygen Saturation ◽  
Fine Print

Object. The poor prognosis for traumatic acute subdural hematoma (ASDH) might be due to underlying primary brain damage, ischemia, or both. Ischemia in ASDH is likely caused by increased intracranial pressure (ICP) leading to decreased cerebral perfusion pressure (CPP), but the degree to which these phenomena occur is unknown. The authors report data obtained before and during removal of ASDH in five cases. Methods. Five patients who underwent emergency evacuation of ASDH were monitored. In all patients, without delaying treatment, a separate surgical team (including the senior author) placed an ICP monitor and a jugular bulb catheter, and in two patients a laser Doppler probe was placed. The ICP prior to removing the bone flap in the five patients was 85, 85, 50, 59, and greater than 40 mm Hg, resulting in CPPs of 25, 3, 25, 56, and less than 50 mm Hg, respectively. Removing the bone flap as well as opening the dura and removing the blood clot produced a significant decrease in ICP and an increase in CPP. Jugular venous oxygen saturation (SjvO2) increased in four patients and decreased in the other during removal of the hematoma. Laser Doppler flow also increased, to 217% and 211% compared with preevacuation flow. Conclusions. Intracranial pressure is higher than previously suspected and CPP is very low in patients with ASDH. Removal of the bone flap yielded a significant reduction in ICP, which was further decreased by opening the dura and evacuating the hematoma. The SjvO2 as well as laser Doppler flow increased in all patients but one immediately after removal of the hematoma.

Cranioplasty with inner table of bone flap

1985 ◽  
Vol 62 (4) ◽  
pp. 607-609 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Hirohiko Gibo ◽  
Shigeaki Kobayashi ◽  
Kenichiro Sugita
Keyword(s):  
Foreign Body Reaction ◽  
Skull Fracture ◽  
Bone Defects ◽  
Skin Incision ◽  
The Body ◽  
Bone Flap ◽  
Growing Skull Fracture ◽  
Content Type ◽  
Additional Exposure ◽  
Fine Print

✓ A new method of cranioplasty is described in which the inner table of the bone flap obtained during craniotomy is used for grafting. The method was used in 10 cases to repair bone defects caused by a growing skull fracture in two, created during removal of an invasive skull tumor in two, during the approach to intraorbital tumors in two, and secondary to craniectomy for additional exposure in four. The method has the advantage that a piece of the inner table for grafting can be obtained from the craniotomy bone flap, without the need for an additional skin incision or taking a graft from another part of the body, and foreign-body reaction is minimal.

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.

Preservation of bone flaps in patients with postcraniotomy infections

2003 ◽  
Vol 98 (6) ◽  
pp. 1203-1207 ◽  
Author(s):  
Jeffrey N. Bruce ◽  
Samuel S. Bruce
Keyword(s):  
Risk Factors ◽  
Recurrent Infection ◽  
Antibiotic Sensitivity ◽  
Surgical Debridement ◽  
Bone Flap ◽  
Wound Infections ◽  
Content Type ◽  
Additional Surgery ◽  
Operative Debridement ◽  
Fine Print

Object. Management of postcraniotomy wound infections has traditionally consisted of operative debridement and removal of devitalized bone flaps followed by delayed cranioplasty. The authors report the highly favorable results of a prospective study in which postcraniotomy wound infections were managed with surgical debridement to preserve the bone flaps and avoid cranioplasty. Methods. Since 1990, 13 patients with postcraniotomy wound infections have been prospectively treated with open surgical debridement and replacement of the bone flap. All patients received a full course of systemic antibiotic agents based on the determination of the bacterial culture and antibiotic sensitivity. Notable risk factors for infection included prior craniotomies, radiotherapy, and skull base procedures. The mean long-term follow-up period was 35 × 20 months. In all five patients who underwent craniotomies without complications, bone flap preservation was possible with full resolution of the infection and without the need for additional surgery. Among the eight patients with risk factors, bone preservation was possible in six patients, although two required minor wound revisions (without bone flap removal). Both patients who underwent craniofacial procedures required an additional procedure in which the bone flap was removed for recurrent infection (one after 2 months and the other after 29 months). Conclusions. In patients with uncomplicated postcraniotomy infections, simple operative debridement is sufficient and it is not necessary to discard the bone flaps and perform cranioplasties. Even patients with risk factors such as prior surgery or radiotherapy can usually be treated using this strategy. Patients who undergo craniofacial surgeries involving the nasal sinuses are at higher risk and may require bone flap removal.

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.

Sign in / Sign up

Export Citation Format

Share Document