The osteomyoplastic flap, a contribution to neurosurgery
Main Article Content
Keywords
Neurosurgery, Surgical procedures, minimally invasive
Abstract
Background: the cosmetic deformities that appear after a pterional craniotomy are usually the result of atrophy of the temporal muscle, lesion of the frontotemporal branch of the facial nerve or occur as a consequence of the way the craniotomy was done.The objective was to compare the functional and aesthetic complications from both the classic pterional approach and the osteomyoplastic flap type approach in patients with supratentorial surgical pathology either vascular or tumoral.
Methods: a retrospective observational, comparative, survey was done. All the patients operated whom required a pterional approach for a supratentorial pathology having performed either a classic pterional approach or an osteomyoplastic pterional flap were included.
Results: the variables: surgical time and hollowing had significant differences; the pterional approach with less approaching time (p < 0.001) and the osteomyoplastic approach with less hollowing perceived by the patients (p = 0.013).
Conclusions: the osteomyoplastic flap showed a less severe hollowing in the temple although it demands more time in order to perform it. The frequency of complications seems to be the same.
References
Balasingam V. Modified osteoplastic orbitozygomatic craniotomy. Technical note. J Neurosurg 2005;102:940-944.
Bowles PA Jr. Reconstruction of the temporalis muscle for pterional and cranio-orbital craniotomies. Surg Neurol 1999; 52:524-529.
Casoli V, Dauphin N. Anatomy and blood supply of the subgaleal fascia flap. Clin Anatomy 2004;17:392.
Davidge K. Naming the soft tissue layers of the temporoparietal region: unifying anatomic terminology across surgical disciplines-surgical anatomy. Neurosurgery 2010; 67(suppl):120-130.
Oikawa S. Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy. J Neurosurg 1996;84:297-299.
Perneczky A, Müller Forell W, Van Lindert E, Fries G. Keyhole concept in neurosurgery. New York: Thieme; 1999.
Yaşargil MG, Reichman MV, Kubik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical note. J Neurosurg 1987;67:463-466.
Dolenc VV. Microsurgical anatomy and surgery of the central skull base. New York: Springer; 2003.
Figueiredo EG. The minipterional craniotomy: Technical description and anatomic assessment. Neurosurgery 2007;61 (suppl):256-267.
Hanasono MM, Utley DS, Goode RL. The temporalis muscle flap for reconstruction after head and neck oncologic surgery. Facial plastic and reconstructive surgery. Laryngoscope 2001;111(10):1719-1725.
Spetzler RF, Lee S. Reconstruction of the temporalis muscle for the pterional craniotomy. Technical note. J Neurosurg 1990;73:636-637.
Yaşargil MG. Microneurosurgery. Volume IVB. New York: Thieme; 1996.
Coscarella E. Subfascial and submuscular methods of temporal muscle dissection and their relationship to the frontal branch of the facial nerve. Technical note. J Neurosurg 2000;92:877-880.
Stuzin J, Wagstrom L, Kawamoto HK, Wolfe A. Anatomy of the frontal branch of the facial nerve: the significance of the temporal fat pad. Plast Reconstr Surg 1989;83(2):265-271.
Kadri P, Al-Mefty O. The anatomical basis for surgical preservation of temporal muscle. J Neurosurg 2004;100: 517-522.
House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146-147.
Krayenbühl N. The relationship of the fronto-temporal branches of the facial nerve to the fascias of the temporal region: a literature review applied to practical anatomical dissection. Neurosurg Rev 2007;30:8-15.
Matic DB, Kim S. Temporal hollowing following coronal incision: a prospective, randomized, controlled trial. Plast Reconstr Surg 2008;121(6):379e-385e.