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A Prospective Comparison Between Soft Tissue Dissection Techniques in Pterional Craniotomy: Functional, Radiological,
Abdulrazag Ajlan1, Sarah Basindwah1, Aysha Hawsawi1
1Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia.
Operative Neurosurgery (Hagerstown, Md.)
|October 10, 2023
Summary
Comparing pterional craniotomy dissection techniques, the interfascial approach showed higher cosmetic satisfaction. The myocutaneous flap technique resulted in more tenderness and temporal hollowing, while subfascial dissection led to the most temporalis muscle thinning.
Area of Science:
- Neurosurgery
- Surgical Techniques
- Anatomy
Background:
- Pterional craniotomy involves complex anatomy and varied surgeon preferences for soft tissue dissection.
- Three common techniques include myocutaneous flap, interfascial, and subfascial dissection.
Purpose of the Study:
- To prospectively compare functional, radiological, and aesthetic outcomes of three pterional craniotomy soft tissue dissection techniques.
- To provide data for neurosurgeons to weigh benefits and risks of each method.
Main Methods:
- A multicenter prospective cohort study of 78 patients undergoing elective pterional craniotomy.
- Patients were divided into three groups based on dissection technique: myocutaneous flap (43%), interfascial (30%), and subfascial (25%).
- Clinical and radiological assessments were conducted at discharge and at 3- and 6-month follow-ups.
Main Results:
- Myocutaneous flap technique had the shortest operative times but higher tenderness and temporal hollowing.
- Interfascial dissection resulted in the highest cosmetic satisfaction.
- Subfascial dissection showed the most severe temporalis muscle thinning; frontalis nerve function was similar across all groups.
Conclusions:
- The choice of soft tissue dissection technique impacts postoperative outcomes, including operative time, tenderness, muscle thickness, and cosmetic satisfaction.
- Interfascial dissection appears favorable for aesthetic results.
- Neurosurgeons should consider these comparative outcomes when selecting a technique for pterional craniotomy.
