Kudulaiti Nijiati, Liu Feili, Hameed N U Farrukh, Wang Peng, Zhang Jie, Feng Rui, Wu Jinsong
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Neurosurgical Institute of Fudan University, Shanghai, China.
Chin Neurosurg J. 2022 Sep 22;8(1):30. doi: 10.1186/s41016-022-00280-6.
Classical pterional appoach for temporal surgeries may cause atrophy and dysfunction of temporalis, injury to the facial nerve, and unnecessary cortical exposure. As an alternative to the classical pterional approach for such surgeries, we hereby describe an mini-temporal approach which reduces these risks and proven to be practical in neurological surgeries.
In the mini-temporal incision design, the frontal end of the incision never surpassed the hairline at the level of temporal line, and a one-layer skin-galea-muscle flap was detached from the cranium, effectively avoiding the injuries of facial nerve. The surgical bone window was completely located underneath the temporalis muscle, allowing it to be completely repositioned postoperatively.
We demonstrated the application of mini-temporal approach in a variety of temporal region tumors, which can be applied to complete successful resective surgeries while effectively reducing injuries to extra-temporal cortex, temporalis, and facial nerve. There were no postoperative complications related to extra-temporal cortical damage, atrophy of temporalis, or injury to the facial nerve.
The mini-temporal approach can effectively shorten the time of craniotomy and closure, decrease the size of bony removal, increase the restoration of temporalis during closure, and lower the chance of facial nerve injury. Therefore, it improves cosmetic outcomes and reduces the risk of unintentional extra-temporal cortical injury, which fully embodies the minimally invasive principle in neurosurgery.
用于颞部手术的经典翼点入路可能导致颞肌萎缩和功能障碍、面神经损伤以及不必要的皮质暴露。作为此类手术经典翼点入路的替代方法，我们在此描述一种微创颞部入路，该入路可降低这些风险，并已证实在神经外科手术中切实可行。
在微创颞部切口设计中，切口的前端从不超过颞上线水平的发际线，从颅骨分离一层皮肤 - 帽状腱膜 - 肌肉瓣，有效避免面神经损伤。手术骨窗完全位于颞肌下方，术后可使其完全复位。
我们展示了微创颞部入路在多种颞部区域肿瘤中的应用，该入路可用于完成成功的切除手术，同时有效减少对颞外皮质、颞肌和面神经的损伤。没有与颞外皮质损伤、颞肌萎缩或面神经损伤相关的术后并发症。
微创颞部入路可有效缩短开颅和关闭时间，减小骨切除范围，增加关闭时颞肌的恢复，降低面神经损伤几率。因此，它改善了美容效果，降低了意外颞外皮质损伤的风险，充分体现了神经外科的微创原则。
