Yangsamit Pakapon, Sriamornrattanakul Kitiporn, Akharathammachote Nasaeng, Phumyoo Thirawass
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Division of Anatomy, Department of Basic Medical Science, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Asian J Neurosurg. 2025 May 20;20(3):590-596. doi: 10.1055/s-0045-1809326. eCollection 2025 Sep.
With the existence of the fibrofatty adhesion (FFA) in the temporal region in relation to the frontotemporal branch of the facial nerve, the suprafascial dissection technique for two-layer pterional scalp flap creation was developed for standard pterional craniotomy. However, the exact anatomy of the FFA has not been well described. We clarified the anatomy of the FFA in cadavers and clinical cases.
Fourteen sides of the cadaveric head were dissected, and the location of the FFA was measured. Twenty patients with cerebral aneurysm who underwent pterional craniotomy using the suprafascial dissection technique between December 2023 and January 2025 were retrospectively reviewed and evaluated for the location of the FFA.
In the cadaveric study, the mean distances between the superoposterior border of the FFA and the junction of the frontozygomatic process (FZP) and zygomatic arch were 2.2, 2.1, and 2.5 cm at the posterior, superoposterior, and superior borders of the FFA, respectively. The superior edge of the FFA was located inferior to the junction of the FZP and the temporal line at 2 and 1.8 cm on average for the cadaveric and clinical study, respectively.
The FFA was located in a small area posterior to the FZP, superior to the zygomatic arch, and below the junction of the FZP and the temporal line. The existence and anatomy of the FFA confirmed the safety of suprafascial dissection for pterional craniotomy. When exposing the zygomatic arch is necessary, interfascial or subfascial dissection must be performed.
由于颞区存在与面神经颞支相关的纤维脂肪粘连（FFA），因此开发了用于标准翼点开颅术的双层翼点头皮瓣的筋膜上剥离技术。然而，FFA的确切解剖结构尚未得到充分描述。我们阐明了尸体和临床病例中FFA的解剖结构。
解剖14侧尸体头部，测量FFA的位置。回顾性分析2023年12月至2025年1月期间20例行翼点开颅术并采用筋膜上剥离技术的脑动脉瘤患者，评估FFA的位置。
在尸体研究中，FFA后缘、后上缘和上缘与额颧突（FZP）和颧弓交界处的平均距离分别为2.2、2.1和2.5cm。在尸体和临床研究中，FFA上缘分别平均位于FZP与颞线交界处下方2cm和1.8cm处。
FFA位于FZP后方、颧弓上方且在FZP与颞线交界处下方的小区域内。FFA的存在及解剖结构证实了翼点开颅术筋膜上剥离的安全性。当需要暴露颧弓时，必须进行筋膜间或筋膜下剥离。
