The Usefulness of Subfascial Temporalis Dissection Method in Pterional Craniotomy

ABSTRACT

The pterional craniotomy is the one of the most frequently used surgical procedures in the field of neurosurgery. Two main methods(muscle-splitting and interfascial technique) of the temporalis dissection and its modifications have been described in detail in the neurosurgical literature. But the muscle splitting technique may limit the exposure of the skull base and the interfascial dissection carries a significant risk of frontalis nerve palsy. The authors have used the subfascial dissection method and compared it with other two techniques in the aspects of functional and cosmetic outcomes. A total of 253 consecutive patients who underwent pterional craniotomies between January 1990 and June 1995 were selected. Among these, interfascial technique was used in 92 patients, muscle-splitting method in 93 patients, and subfascial temporalis dissection in 68 patients . The patients were examined to compare the incidence of facial nerve palsy, the presence of chewing difficulty, temporal asymmetry and the degree of maximal mouth opening. The interfascial approach showed the worst outcome in preserving frontalis nerve and maintaining temporal symmetry(p<0.05). There were no significant differences among these three techniques in maximal mouth opening and chewing difficulties. In conclusion, the subfascial temporalis dissection technique enable many surgeons to perform pterional craniotomies without fear of frontalis nerve injury while obtainig satisfactory operative exposure. We believe this is the choice of dissection method when performing pterional craniotomy.