Nijiati Kudulaiti1,2,3,4, Feili Liu1,2,3,4, N U Farrukh Hameed1,2,3,4, Peng Wang1,2,3,4, Jie Zhang1,2,3,4, Rui Feng5,6,7,8, Jinsong Wu1,2,3,4. 1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. 2. Neurosurgical Institute of Fudan University, Shanghai, China. 3. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. 4. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China. 5. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. fengrui@huashan.org.cn. 6. Neurosurgical Institute of Fudan University, Shanghai, China. fengrui@huashan.org.cn. 7. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. fengrui@huashan.org.cn. 8. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China. fengrui@huashan.org.cn.
Abstract
BACKGROUND: Classical pterional appoach for temporal surgeries may cause atrophy and dysfunction of temporalis, injury to the facial nerve, and unnecessary cortical exposure. As an alternative to the classical pterional approach for such surgeries, we hereby describe an mini-temporal approach which reduces these risks and proven to be practical in neurological surgeries. MATERIAL AND METHODS: In the mini-temporal incision design, the frontal end of the incision never surpassed the hairline at the level of temporal line, and a one-layer skin-galea-muscle flap was detached from the cranium, effectively avoiding the injuries of facial nerve. The surgical bone window was completely located underneath the temporalis muscle, allowing it to be completely repositioned postoperatively. RESULTS: We demonstrated the application of mini-temporal approach in a variety of temporal region tumors, which can be applied to complete successful resective surgeries while effectively reducing injuries to extra-temporal cortex, temporalis, and facial nerve. There were no postoperative complications related to extra-temporal cortical damage, atrophy of temporalis, or injury to the facial nerve. CONCLUSION: The mini-temporal approach can effectively shorten the time of craniotomy and closure, decrease the size of bony removal, increase the restoration of temporalis during closure, and lower the chance of facial nerve injury. Therefore, it improves cosmetic outcomes and reduces the risk of unintentional extra-temporal cortical injury, which fully embodies the minimally invasive principle in neurosurgery.
BACKGROUND: Classical pterional appoach for temporal surgeries may cause atrophy and dysfunction of temporalis, injury to the facial nerve, and unnecessary cortical exposure. As an alternative to the classical pterional approach for such surgeries, we hereby describe an mini-temporal approach which reduces these risks and proven to be practical in neurological surgeries. MATERIAL AND METHODS: In the mini-temporal incision design, the frontal end of the incision never surpassed the hairline at the level of temporal line, and a one-layer skin-galea-muscle flap was detached from the cranium, effectively avoiding the injuries of facial nerve. The surgical bone window was completely located underneath the temporalis muscle, allowing it to be completely repositioned postoperatively. RESULTS: We demonstrated the application of mini-temporal approach in a variety of temporal region tumors, which can be applied to complete successful resective surgeries while effectively reducing injuries to extra-temporal cortex, temporalis, and facial nerve. There were no postoperative complications related to extra-temporal cortical damage, atrophy of temporalis, or injury to the facial nerve. CONCLUSION: The mini-temporal approach can effectively shorten the time of craniotomy and closure, decrease the size of bony removal, increase the restoration of temporalis during closure, and lower the chance of facial nerve injury. Therefore, it improves cosmetic outcomes and reduces the risk of unintentional extra-temporal cortical injury, which fully embodies the minimally invasive principle in neurosurgery.
Authors: Eberval Gadelha Figueiredo; Pushpa Deshmukh; Joseph M Zabramski; Mark C Preul; Neil R Crawford; Robert F Spetzler Journal: Neurosurgery Date: 2006-10 Impact factor: 4.654