Ealmaan Kim1, Johnny B Delashaw. 1. Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
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.
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.
Authors: Daniel Buzaglo Gonçalves; Maria Izabel Andrade Dos Santos; Lucas de Cristo Rojas Cabral; Louise Makarem Oliveira; Gabriela Campos da Silva Coutinho; Bruna Guimarães Dutra; Rodrigo Viana Martins; Franklin Reis; Wellingson Silva Paiva; Robson Luis Oliveira de Amorim Journal: Surg Neurol Int Date: 2021-09-13