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Ajlan A, Basindwah S, Hawsawi A, Alsabbagh B, Alwadee R, Abdulqader SB, Alzhrani G, Orz Y, Bafaqeeh M, Alobaid A, Alyamany M, Farrash F, Alaskar A, Alkhathlan M, Alqurashi A, Elwatidy S. A Prospective Comparison Between Soft Tissue Dissection Techniques in Pterional Craniotomy: Functional, Radiological, and Aesthetic Outcomes. Oper Neurosurg (Hagerstown) 2024; 26:256-267. [PMID: 37815213 DOI: 10.1227/ons.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/04/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Given the complex anatomy of the operative region and individual surgeon preferences, some techniques for soft tissue dissection before pterional craniotomy have gained more popularity than others. This prospective study used subjective and objective measurements to compare the functional, radiological, and aesthetic outcomes of 3 such dissection techniques. METHODS This multicenter prospective cohort study included all patients who underwent elective pterional craniotomy between 2018 and 2020 at 3 centers in Riyadh, Saudi Arabia. All patients underwent 1 of 3 soft tissue dissection techniques: myocutaneous flap, interfascial, and subfascial dissection techniques. Clinical and radiological assessments were performed upon discharge and at the 3- and 6-month follow-ups. RESULTS We included 78 patients, with a mean age of 44.9 ± 16.3 years. Myocutaneous flap, interfascial, and subfascial dissections were performed in 34 (43%), 24 (30%), and 20 patients (25%), respectively. The myocutaneous flap method had the shortest opening ( P = .001) and closure ( P = .005) times; tenderness was more evident in this group than in the others ( P = .05). The frontalis muscle was most affected in the interfascial dissection group ( P = .05). The frontalis nerve function was similar in all groups after 6 months ( P = .54). The incidence of temporomandibular joint dysfunction was highest in the myocutaneous flap group (29%). Decreased temporalis muscle thickness at the 6-month postoperative follow-up was most severe in the subfascial dissection group (12.6%), followed by the myocutaneous flap (11.9%) and interfascial dissection (9.9%) groups, with no significant difference ( P = .85). Temporal hollowing was more prominent in the myocutaneous flap group ( P = .03). Cosmetic satisfaction was highest in the interfascial dissection group, with no significant difference ( P = .4). CONCLUSION This study provides important information for neurosurgeons in weighing the benefits and risks of each technique for their patients.
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Affiliation(s)
- Abdulrazag Ajlan
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Sarah Basindwah
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Aysha Hawsawi
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Badriah Alsabbagh
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Rawan Alwadee
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | | | - Gmaan Alzhrani
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Yasser Orz
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Mohammed Bafaqeeh
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Abdullah Alobaid
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Mahmoud Alyamany
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Faisal Farrash
- Division of Neurosurgery, Department of Neuroscience, King Faisal Hospital and Research Center, Riyadh , Saudi Arabia
| | - Abdulaziz Alaskar
- College of Medicine, Prince Sattam Bin Abdulaziz University, Riyadh , Saudi Arabia
| | - Malak Alkhathlan
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Ashwag Alqurashi
- Division of Neurosurgery, Department of Surgery, King Saud University Medical City, Riyadh , Saudi Arabia
| | - Sherif Elwatidy
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
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Finger G, Kaul VF, Adunka OF, Prevedello DM. Subfascial dissection and extended temporal muscle detachment for middle fossa approach. Acta Neurochir (Wien) 2023; 165:3473-3477. [PMID: 36625906 DOI: 10.1007/s00701-022-05483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The soft tissue dissection for the middle fossa approach requires adequate management of the neuro, vascular, and muscular structures in order to maximize exposure and diminish morbidities. METHODS An incision anterior to the tragus is performed, extending from the zygomatic process to the superior temporal line. The superior temporal artery is exposed, followed by a subfascial dissection of the frontalis nerve. The temporal muscle is dissected and released from the zygoma. All cranial landmarks are exposed for the 5 × 5 cm temporal fossa craniotomy. CONCLUSION This novel approach provides a safe and adequate access to perform an extended middle fossa craniotomy.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10Th Ave, Columbus, OH, 43210, USA.
| | - Vivian F Kaul
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Oliver F Adunka
- Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10Th Ave, Columbus, OH, 43210, USA
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Graziano F, Scalia G, Paolini F, Umana GE, Maugeri R, Iacopino DG, Nicoletti GF. "The Double S" Technique: Subfascial Dissection and Temporalis Muscle Splitting to Prevent Cerebrospinal Fluid Leak and Maximize Surgical Exposure. J Craniofac Surg 2023; 34:1067-1070. [PMID: 36217226 DOI: 10.1097/scs.0000000000009051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Middle cranial fossa surgery commonly is approached either performing a subtemporal or a pterional craniotomy. To maximize a basitemporal region exposure, an adjunctive bone drilling could be required. In these cases, a watertight dura and temporalis muscle closure are mandatory. OBJECTIVE To describe a modified temporalis muscle dissection in middle cranial fossa surgery to increase basitemporal region exposure while assuring a safe and effective closure thus avoiding cerebrospinal fluid (CSF) leakage. METHODS A total of 8 patients have been enrolled. Five pterional and 3 subtemporal approaches were performed. In all cases, the novel subfascial muscle dissection and temporalis muscle splitting technique named "the double S technique," was performed to cut up the temporal muscle. RESULTS In all cases, a subgaleal drainage was used and removed within 48 hours. No cases of postoperative CSF leak or hematoma collection were reported. CONCLUSIONS The double S technique is a safe and effective alternative to enhance the basitemporal region exposure while avoiding the potential, common risk of CSF leak.
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Affiliation(s)
- Francesca Graziano
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Catania
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Catania
| | - Federica Paolini
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo
| | - Giuseppe E Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo
| | - Domenico G Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo
| | - Giovanni F Nicoletti
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Catania
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Scalp complications of craniofacial surgery: classification, prevention, and initial approach: an updated review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-02008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Scalp complications in craniofacial surgeries can increase morbidity and mortality. Given the inelastic characteristics of the scalp, these surgeries can be challenging, and multiple complications can arise. The literature on craniofacial surgery is extensive. However, few articles address scalp complications, associated factors, and prevention. This study aims to identify and classify scalp complications in craniofacial surgery and describe associated risk factors, general preventive measures, and an initial therapeutic approach.
Methods
We conducted a literature search in PubMed, Scopus, Cochrane Library, and LILACS to review the scalp complications in craniofacial surgery. The studies selected included retrospective case series, narrative reviews, systematic reviews, and cadaveric anatomic studies. We completed the search with book chapters and specific topic reviews.
Results
We screened a total of 124 sources and selected 35 items for inclusion in this review. Based on the updated review, we categorized scalp complications into wound defects, soft tissue contour irregularities, neurovascular defects, and infection. We discuss the main characteristics, risk factors, preventive measures, and initial management of these complications.
Conclusions
For craniofacial surgery, understanding the surgical anatomy, identifying risk factors, adequate surgical planning, and interdisciplinary cooperation between neurosurgeons, plastic surgeons, and the interdisciplinary team are essential to prevent and treat scalp complications.
Level of evidence: Not ratable
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Morandi EM, Pinggera D, Kerschbaumer J, Rauchenwald T, Winkelmann S, Thomé C, Pierer G, Wolfram D. Correction of temporal hollowing after pterional craniotomy by autologous fat grafting. A single-center experience. World Neurosurg 2022; 164:e784-e791. [PMID: 35597536 DOI: 10.1016/j.wneu.2022.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aesthetic complications following neurosurgical procedures impact patient quality of life and self-perception. Postoperative temporal hollowing is frequently seen after temporal craniotomy, resulting mainly from atrophy of the temporal muscle. Autologous fat grafting is a tailorable method to correct such approach-related sequelae. We herein present our clinical patient series and discuss pearls and pitfalls of this method. METHODS In this retrospective single-center study, correction of postoperative temporal hollowing using autologous fat grafting was performed in 16 patients. Temporal tissue thickness ratio was measured using magnetic resonance tomography images to visualize the graft. Patients, plastic surgeons and neurosurgeons evaluated the results independently using the herein presented scale. RESULTS The mean interval between the neurosurgical procedure and fat grafting was 62 months. A mean volume of 11.5 ml autologous fat was injected in an average of 2.5 sessions after initial rigotomy. Temporal tissue thickness was significantly augmented at a mean of 2.2 years after the operation (mean 0.71 ± 0.25, range 0.43-1.1; p=0.0214) as compared to the preoperative finding (mean 0.48 ± 0.1, range 0.32-0.6). Patients were more satisfied with the results than were surgeons, reflecting the significant impact of the deformity on patient self-esteem. CONCLUSIONS Autologous fat grafting is a valuable method for correcting postoperative temporal hollowing that provides stable results, high patient and surgeon satisfaction and can be tailored to the patient's individual needs. It should not be considered a merely aesthetic operation, but an important rehabilitation step towards restoring the patient's quality of life.
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Affiliation(s)
- Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Selina Winkelmann
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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