Reconstruction of the temporalis muscle for the pterional craniotomy

Rf, Spetzler; Ks, Lee

doi:10.3171/jns.1990.73.4.0636

Cited by 102 publications

(66 citation statements)

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“…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%

“…On the other hand, the sulcus lateralis (Sylvian) access to the anterior supratentorial basal midline does not need a very low level of the flap 7 , and the inconvenience created by the flap width can be easily turned through hook traction below the sphenoid ridge 2,3 .…”

mentioning

confidence: 99%

“…10 . Meanwhile, there are few reports on the temporalis muscle atrophy that follows this procedure 2,3 .…”

mentioning

confidence: 99%

“…This maneuver permits the sliding and translation of the temporalis muscle to posteroinferior position of the exposure and opens wide the anteroinferior pterional access by decreasing the flap width in this corner. 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.…”

mentioning

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%

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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: Surgical Techniquementioning

confidence: 99%

mentioning

confidence: 99%

“…10 . Meanwhile, there are few reports on the temporalis muscle atrophy that follows this procedure 2,3 .…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%