Seçer Mehmet, Çam İsa, Gökbel Aykut, Ulutaş Murat, Çakır Özgür, Ergen Anıl, Çınar Kadir
Department of Neurosurgery, Alaaddin Keykubat University School of Medicine, Alanya, Antalya, Turkey.
Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey.
J Neurol Surg B Skull Base. 2021 Dec 29;83(5):554-558. doi: 10.1055/s-0041-1741005. eCollection 2022 Oct.
Pterional craniotomy is a surgical approach frequently used in aneurysm and skull base surgery. Pterional craniotomy may lead to cosmetic and functional problems, such as eyebrow drop due to facial nerve frontal branch damage, temporal muscle atrophy, and temporomandibular joint pain. The aim was to compare the postoperative effects of our modified osteoplastic craniotomy with classical pterional craniotomy in terms of any change in volume of temporal muscle and in the degree of frontal muscle nerve damage. Aneurysm cases were operated with either modified osteoplastic pterional craniotomy or free bone flap pterional craniotomy according to the surgeon's preference. Outcomes were compared in terms of temporal muscle volume and frontal muscle nerve function 6 months postoperatively. Preoperative temporal muscle volume in the modified osteoplastic pterional and free bone flap pterional craniotomy groups were not different ( > 0.05). However, significantly less atrophy was observed in the postoperative temporal muscle volume of the osteoplastic group compared with the classical craniotomy group ( < 0.001). In addition, when comparing frontal muscle nerve function there was less nerve damage in the modified osteoplastic pterional craniotomy group compared with the classical craniotomy group, although this did not reach significance ( > 0.05). Modified osteoplastic pterional craniotomy significantly reduced atrophy of temporal muscle and caused proportionally less frontal muscle nerve damage compared with pterional craniotomy, although this latter outcome was not significant. These findings suggest that osteoplastic craniotomy may be a more advantageous intervention in cosmetic and functional terms compared with classical pterional craniotomy.
翼点入路开颅术是动脉瘤和颅底手术中常用的手术方法。翼点入路开颅术可能会导致美容和功能问题，如因面神经额支损伤导致的眉下垂、颞肌萎缩和颞下颌关节疼痛。目的是比较改良骨成形开颅术与经典翼点入路开颅术在颞肌体积变化和额肌神经损伤程度方面的术后效果。
根据外科医生的偏好，动脉瘤病例采用改良骨成形翼点入路开颅术或游离骨瓣翼点入路开颅术进行手术。术后6个月比较颞肌体积和额肌神经功能方面的结果。
改良骨成形翼点入路开颅术组和游离骨瓣翼点入路开颅术组术前颞肌体积无差异（ > 0.05）。然而，与经典开颅术组相比，骨成形术组术后颞肌体积萎缩明显较少（ < 0.001）。此外，比较额肌神经功能时，改良骨成形翼点入路开颅术组的神经损伤比经典开颅术组少，尽管差异无统计学意义（ > 0.05）。
与翼点入路开颅术相比，改良骨成形翼点入路开颅术显著减少了颞肌萎缩，且额肌神经损伤比例较小，尽管后一结果无统计学意义。这些发现表明，与经典翼点入路开颅术相比，骨成形开颅术在美容和功能方面可能是一种更具优势的干预方法。
