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

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.

Effects of Pterional and Osteoplastic Craniotomy on Temporalis Muscle and Calvarial Bone Graft Atrophy

“…Seçer and colleagues studied temporalis muscle volume and frontalis nerve function sixth month after osteoplastic and standard pterional craniotomy. They discovered that the osteoplastic craniotomy group had less temporalis muscle atrophy than the standard craniotomy group ( P <0.001) 15 . In our study, the osteoplastic craniotomy group had less atrophy in the temporalis muscle and craniotomy bones.…”

“…They discovered that the osteoplastic craniotomy group had less temporalis muscle atrophy than the standard craniotomy group (P < 0.001). 15 In our study, the osteoplastic craniotomy group had less atrophy in the temporalis muscle and craniotomy bones.…”

“…Seçer et al 15 found no difference in postoperative frontalis nerve injury between osteoplastic craniotomy and standard craniotomy. We found no functional disturbances during postoperative neurological examinations in our study, despite the fact that no patients had electromyography.…”

‘What’s in a name’, a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

“…Four articles [ 12 , 17 , 22 , 36 ] describe a single myocutaneous flap. Three articles [ 41 , 77 , 78 ] describe an osteoplastic craniotomy. One article [ 75 ] describes a T-shaped incision with subperiosteal dissection of each limb, and another article [ 70 ] describes incising the muscle along the attachment to the STL and dissecting subperiosteally.…”

“…2 ). Nineteen articles [ 2 , 12 , 15 , 22 , 32 , 35 , 39 , 42 , 51 , 53 , 56 , 59 , 70 , 76 – 78 , 81 , 83 , 85 ] described a craniotomy that involved removing bone from the fronto-spheno-temporal area (cyan). Eight articles [ 1 , 6 , 20 , 25 , 31 , 38 , 48 , 79 ] described a craniotomy that involved removing bone from the fronto-spheno-zygomatic area (dark blue).…”