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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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Pterional craniotomy without keyhole to supratentorial cerebral aneurysms: technical note
1Department of Neurosurgery, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, South Korea.
Background:
Patients who have pterional craniotomy occasionally complain of scalp deformity at the frontotemporal area because of craniotomy site. Especially, this occurs as a result of inappropriate repair of the bony defect at the keyhole with the complex curvature of the surrounding bone, although burr holes buttons are used. The author presents results of pterional craniotomy that is performed without keyhole to supratentorial cerebral aneurysms.
Methods:
The temporal muscle was incised a few millimeters before its insertion at the superior temporal line, leaving a small fascial cuff for anatomic reattachment during closure. Only one burr hole was placed on the superior temporal line 3 to 4 cm posteriorly from the frontal base. After clipping of aneurysm, the bone flap was fixed using a titanium clamp (CranioFix) for a burr hole and 2 miniplates.
Results:
Postoperative three-dimensional computerized tomography scans and photographs reveal excellent cosmetic results with the smooth cranial surface without scalp deformity at 6-month follow-up. Dural laceration developed in two cases, but there was no cerebral spinal fluid leakage after repair.
Conclusion:
Our technique offers good cosmetic results and less risk of disaster by intraoperative rupture of aneurysm than the keyhole surgery.
