Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, India.
Department of Neurosurgery, I.R.C.C.S. NEUROMED, Pozzilli (IS), Italy.
Neurol India. 2022 Jul-Aug;70(4):1391-1395. doi: 10.4103/0028-3886.355156.
The current technique of pterional craniotomy involves temporalis muscle incision followed by retrograde elevation. Feasibility of antegrade temporalis muscle elevation without any direct incision over its bulk is evaluated.
Incisionless "antegrade, subgaleal, subfascial, and subperiosteal elevation" of temporalis muscle preserves vascularity and muscle bulk. Posterior maneuvering of "bare" temporalis muscle bulk either above (out rolling) or under (in rolling) the scalp for pterional craniotomy is discussed.
Technique of antegrade, subfascial, subperiosteal elevation, and posterior rotation of temporalis muscle without incising in its bulk by "out rolling" or "in rolling" along the posterior aspect of the scalp incision was carried out in 15 cadavers and later in 50 surgical cases undergoing pterional craniotomy. Postoperatively, patients were evaluated for subgaleal collection and periorbital edema. Operated side cosmesis and temporalis muscle bulk was compared with nonoperated temporalis muscle at 6 months interval.
Antegrade subperiosteal dissection of temporalis muscle was possible in all cases. "In-rolling" or "out rolling" technique provided adequate surgical exposure during pterional craniotomy. Postoperative subgaleal collection and periorbital edema was prevented. Facial nerve paresis or temporalis muscle-related complications were avoided.
Antegrade, subgaleal, subfascial, and subperiosteal dissection techniques of temporalis muscle elevation without any direct incision in its bulk enables neurovascular and muscle volume preservation. Posterior maneuvering of elevated temporalis muscle with "out rolling" or "in-rolling" technique is easy, quick, and provides adequate exposure during pterional craniotomy. Opening and closing of scalp layers without violating subgaleal space prevent postoperative subgaleal hematoma and periorbital edema.
翼点开颅术目前的技术涉及颞肌切开，然后逆行抬高。评估不直接切开其大部分进行顺行颞肌抬高的可行性。
无切口的“顺行、皮下、筋膜下和骨膜下颞肌抬高”可保持血管和肌肉体积。讨论翼点开颅术中在头皮切口后通过“外滚”或“内滚”对“裸露”颞肌块进行后向操作。
在 15 具尸体和随后的 50 例翼点开颅术手术中，通过“外滚”或“内滚”沿头皮切口后缘，对颞肌进行顺行筋膜下、骨膜下抬高和后旋，而不切开其大部分。术后评估患者的皮下血肿和眶周水肿。术后 6 个月比较手术侧美容效果和颞肌体积与非手术侧颞肌。
所有病例均可行顺行骨膜下颞肌剥离。“内滚”或“外滚”技术在翼点开颅术中提供了足够的手术暴露。预防术后皮下血肿和眶周水肿。避免面神经麻痹或颞肌相关并发症。
不直接切开颞肌大部分的顺行、皮下、筋膜下和骨膜下颞肌抬高技术可保留神经血管和肌肉体积。通过“外滚”或“内滚”技术对抬高的颞肌进行后向操作简单、快速，在翼点开颅术中提供足够的暴露。不侵犯皮下间隙打开和关闭头皮层可防止术后皮下血肿和眶周水肿。
