1Department of Neurosurgery, Stanford Hospital, Stanford, California.
2Department of Neurosurgery, University of California, Irvine, Orange, California.
J Neurosurg. 2023 Mar 10;139(4):1160-1168. doi: 10.3171/2023.1.JNS222027. Print 2023 Oct 1.
The anatomy of the temporal branches of the facial nerve (FN) has been widely described in the neurosurgical literature because of its relevance in anterolateral approaches to the skull base and implication in frontalis palsies from these approaches. In this study, the authors attempted to describe the anatomy of the temporal branches of the FN and identify whether there are any FN branches that cross the interfascial space of the superficial and deep leaflets of the temporalis fascia.
The surgical anatomy of the temporal branches of the FN was studied bilaterally in 5 embalmed heads (n = 10 extracranial FNs). Exquisite dissections were performed to preserve the relationships of the branches of the FN and their relationship to the surrounding fascia of the temporalis muscle, the interfascial fat pad, the surrounding nerve branches, and their final terminal endpoints near the frontalis and temporalis muscles. The authors correlated their findings intraoperatively with 6 consecutive patients with interfascial dissection in which neuromonitoring was performed to stimulate the FN and associated twigs that were observed to be interfascial in 2 of them.
The temporal branches of the FN stay predominantly superficial to the superficial leaflet of the temporal fascia in the loose areolar tissue near the superficial fat pad. As they course over the frontotemporal region, they give off a twig that anastomoses with the zygomaticotemporal branch of the trigeminal nerve, which crosses the superficial layer of the temporalis muscle, spanning the interfascial fat pad, and then pierces the deep temporalis fascial layer. This anatomy was observed in 10 of the 10 FNs dissected. Intraoperatively, stimulation of this interfascial segment yielded no facial muscle response up to 1 mA in any of the patients.
The temporal branch of the FN gives off a twig that anastomoses with the zygomaticotemporal nerve, which crosses the superficial and deep leaflets of the temporal fascia. Interfascial surgical techniques aimed at protecting the frontalis branch of the FN are safe in their efforts to protect against frontalis palsy with no clinical sequelae when executed properly.
面神经颞支的解剖结构在神经外科学文献中已有广泛描述，因为它与颅底前外侧入路有关，并且与这些入路引起的额肌瘫痪有关。在这项研究中，作者试图描述面神经颞支的解剖结构，并确定是否有面神经分支穿过颞筋膜浅、深叶之间的筋膜间隙。
在 5 具防腐头颅（n=10 条颅外面神经）双侧研究面神经颞支的外科解剖。进行精细解剖以保留面神经分支及其与颞肌周围筋膜、筋膜间隙脂肪垫、周围神经分支及其在额肌和颞肌附近的终末终点的关系。作者将他们的发现与 6 例连续的筋膜间隙解剖患者相关联，在这些患者中进行了神经监测以刺激面神经及其相关分支，其中 2 例观察到分支位于筋膜间隙内。
面神经颞支主要位于颞筋膜浅层的疏松纤维组织中，靠近浅脂肪垫。当它们在额颞区域走行时，发出一个分支与三叉神经颧颞支吻合，该分支穿过颞肌浅层，跨越筋膜间隙脂肪垫，然后穿过颞筋膜深层。在 10 个解剖的面神经中均观察到这种解剖结构。术中刺激这个筋膜间隙段，在任何患者中，刺激强度高达 1 mA 时均未引起面肌反应。
面神经颞支发出一个分支与颧颞神经吻合，该分支穿过颞筋膜的浅、深叶。旨在保护面神经额支的筋膜间隙手术技术在正确执行时是安全的，可以防止额肌瘫痪而无临床后遗症。
