Cosmetic and functional reconstruction achieved using a split myofascial bone flap for pterional craniotomy. Technical note.

Cosmetic deformities that appear following pterional craniotomy are usually caused by temporal muscle atrophy, injury to the frontotemporal branch of the facial nerve, or bone pits in the craniotomy line. To resolve these problems during pterional craniotomy, an alternative method was developed in which a split myofascial bone flap and a free bone flap are used. The authors have used this method in the treatment of 40 patients over the last 3 years. Excellent cosmetic and functional results have been obtained. This method can provide wide exposure similar to that achieved using Yasargil's interfascial pterional craniotomy, without limiting the operative field with a bulky temporal muscle flap.

[Surgical treatment of unruptured cerebral aneurysms and complications in patients with ischemic cerebrovascular disease].

Patients who have unruptured intracranial aneurysms associated with ischemic cerebrovascular disease are a high-risk group for surgery. We have done clipping surgery in 15 patients among 40 with ischemic cerebrovascular disease. The criteria for surgery included an age below 65 years, CBF of more than 35 ml/100 g/min, and favorable ADL comparable to Rankin score 0-III. Two patients received simultaneous aneurysm clipping and superficial-middle cerebral artery anastomosis. Only one patient suffered from ischemia-related permanent neurological worsening, and one had direct optic nerve injury. Surgical mortality was 0%, and morbidity was 15%. There were two patients who had transient neurological worsening. These results suggest that surgical treatment of unruptured cerebral aneurysms is not contraindicated in patients with ischemic brain disease, but careful selection and careful perioperative management are mandatory for preventing surgical complications.