Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy

Yaşargil, M. Gazi; Reichman, Mark V.; Kubík, S

doi:10.3171/jns.1987.67.3.0463

Cited by 251 publications

(162 citation statements)

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“…The bigger TFDS observed at IF series explains itself by the greater technical complex in the making and flap synthesis of this variant, aiming the protection of the facial temporofrontalis limbs [4][5][6] . There were no significant statistical differences in the remaining data analyzed in the study.…”

Section: Discussionmentioning

confidence: 99%

“…In the MC group the the technique of flap's dieresis (and synthesis) was employed, as detailed in the technical note by Spetzler & Lee 3 , and in IF group the technique detailed by Yasargil et al [4][5][6] was employed. The procedures were always performed by the same surgical team, with the same materials and surgical tools.…”

Section: Surgical Techniquementioning

confidence: 99%

“…For the pterional craniotomy, different incisions were employed in the scalp and temporalis muscle [1][2][3][4][5][6] . To improve the anterior basal exposition of the pterional approach, the onelayer flap or myocutaneous (MC) may be splitted in two layers.…”

mentioning

confidence: 99%

“…5 Following the twolayers flap dieresis it is frequent the palsy of frontotemporal branches of the facial nerve (30%) [2][3][4] , temporalis muscle atrophy and temporomandibularis joint dysfunction [1][2][3][7][8][9] . The technical interfascial variant (IF) [4][5][6] drastically decreased the incidence of the frontotemporal branches' palsy of facial nerve, but not at all. 10 .…”

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confidence: 99%

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Dysfunction of the temporalis muscle after pterional craniotomy for intracranial aneurysms: comparative, prospective and randomized study of one flap versus two flaps dieresis

Andrade

Filho

1998

Arq. Neuro-Psiquiatr.

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-Patients with intracranial aneurysm(s) of the carotid artery territory, treated with pterional craniotomy, were prospectively and randomly addressed to one layer flap (n=36) or myocutaneous (MC) versus two layers' dieresis (n=32) or interfascial (IF). The study protocol included the patient's sex, age, area of craniotomy, time of flap dieresis and synthesis, time of bone dieresis and synthesis, the intracranial time, including dura mater dieresis and synthesis and time of flap retraction. Before and after surgery, the patients were evaluated with examination specially oriented to V and VII cranial nerves, bi-temporal diameter measurement, the symmetry of the temporal region, tempora-mandibularis joint (TMJ) movements and cranial CT scan. The evaluations of the TMJ dysfunctions were postoperative pain, movement limitations at mastication, occlusion, mouth aperture and lateral movements of the jaw. The statistical analysis showed that the incidence of pain at TMJ and moderate and severe temporalis muscle atrophy was observed, comparing MC and IF, and there were significant differences among these ones, being greater in IF group. We concluded that both techniques permit equivalent access to the studied intracranial aneurysm(s), and the atrophy of temporalis muscle, pain and movement limitations of the temporomandibularis joint were prevalent, worse and more long-lasting in two-layers flap dieresis than in onelayer flap dieresis.KEY WORDS: atrophy temporalis muscle, intracranial aneurysm, postoperative complications, pterional craniotomy, surgical technique, temporalis muscle, temporomandibularis joint.Disfunção do músculo temporal após craniotomia pterional para tratamento de aneurismas intracranianos: estudo comparativo, prospectivo e aleatório da diérese em camada única versus camada dupla RESUMO -Pacientes com aneurisma(s) intracraniano(s) foram tratados pela via pterional e de modo prospectivo e aleatório submetidos às variantes técnicas, miocutânea (MC)(n=36) ou em retalho único e interfascial (IF) (n=32) ou em retalho duplo. No protocolo foram anotados o sexo, idade, área da craniotomia, período de diérese e síntese do retalho, período de diérese e síntese óssea, o período do procedimento intracraniano, incluindo o tempo de diérese e síntese da dura-máter e o período de retração do retalho. Os pacientes foram avaliados antes e após cirurgia, com exame neurológico especialmente orientado para o V e VII pares de nervos cranianos, medida do diâmetro bi-temporal, simetria das regiões temporais, movimentação da articulação temporomandibular (ATM) e tomografia computadorizada de crânio. A ATM foi avaliada em relação a dor articular pós-operatória, limitação dos movimentos a mastigação, oclusão, abertura da boca e movimentos laterais da mandíbula. A análise estatística mostrou que a incidência de dor na ATM e atrofia temporal moderada e grave, comparando MC com IF, houve diferenças significativas entre estes, sendo maior no grupo IF. Concluimos que ambas técnicas permitem acessos equivalentes aos aneurisma...

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Dysfunction of the temporalis muscle after pterional craniotomy for intracranial aneurysms: comparative, prospective and randomized study of one flap versus two flaps dieresis

Andrade

Filho

1998

Arq. Neuro-Psiquiatr.

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“…Em seguida, inclina-se anterior e medialmente, sempre logo atrás da linha de implantação do cabelo, terminando na linha mediana. Seguindo a técnica interfascial temporal descrita por Yasargil e col. 15 , a dissecção do flape cutâneo é realizada, expondo-se mais amplamente, contudo, a porção lateral da reborda orbitária superior, o processo zigomático do osso frontal, o arco e o osso zigomáticos até o forame zigomático-facial. Com o uso de dissector curvo, a periórbita é delicadamente descolada da face interna do teto e da parede lateral da órbita.…”

Section: Técnica Cirúrgicaunclassified

Acesso crânio-orbitozigomático em flape único: técnica cirúrgica e resultados

Giannetti

Faleiro²,

Perpétuo

1999

Arq. Neuro-Psiquiatr.

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RESUMO -Descreve-se o acesso crânio-orbitozigomático em flape único, cuja técnica foi aplicada em sete pacientes (cinco aneurismas da artéria basilar, um neurinoma do trigêmeo e um meningioma da asa menor do esfenóide). Os pacientes foram retrospecticamente analisados do ponto de vista estético e submetidos a tomografia computadorizada com reconstruções tridimensionais e multiplanares. O acesso proporcionou maior campo de trabalho, menor profundidade e maiores possibilidades de angulação do microscópio, permitindo a clipagem satisfatória dos aneurismas e a ressecção completa dos tumores. A paralisia do músculo frontal ocorreu em dois casos e a atrofia do músculo temporal provocou defeito estético significativo em dois pacientes. Não houve enoftalmia ou afundamento do flape ósseo. A técnica apresentada pareceu-nos mais simples e acessível ao nosso meio, dispensando o uso de motores, serras elétricas e de miniplacas. PALAVRAS-CHAVE: acesso cirúrgico, cirurgia de base de crânio, aneurisma intracraniano, técnica operatória. An en bloc cranio-orbitozygomatic approach: surgical technique and resultsABSTRACT -An en bloc cranio-orbitozygomatic approach is described. This technique was applied in seven patients (five basilar artery aneurysms, a trigeminal neuroma, a meningioma of the lesser sphenoid wing). The follow-up period ranged from 3 to 50 months. The patients were retrospectively analysed from the cosmetic point of view, and submitted to computerized tomography with three dimensional and multiplanar reconstructions The access provided a wider operative field with a shorter distance to the pathology and possibility of increased angulation of the microscope. The aneurysms could be cliped and the tumors completelly removed in all cases. A frontalis muscle paralysis occurred in two cases, as well as a temporalis muscle atrophy in another two patients. There were no enophthalmos or bone flap displacements. The surgical technique is simple and do not require drills, electric saws and miniplates.KEY WORDS: surgical approach, skull base surgery, intracranial aneurysm, operative technique.

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