A Prospective Comparison Between Soft Tissue Dissection Techniques in Pterional Craniotomy: Functional, Radiological, and Aesthetic Outcomes.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
09 Oct 2023
09 Oct 2023
Historique:
received:
12
05
2023
accepted:
04
08
2023
medline:
10
10
2023
pubmed:
10
10
2023
entrez:
10
10
2023
Statut:
aheadofprint
Résumé
Given the complex anatomy of the operative region and individual surgeon preferences, some techniques for soft tissue dissection before pterional craniotomy have gained more popularity than others. This prospective study used subjective and objective measurements to compare the functional, radiological, and aesthetic outcomes of 3 such dissection techniques. This multicenter prospective cohort study included all patients who underwent elective pterional craniotomy between 2018 and 2020 at 3 centers in Riyadh, Saudi Arabia. All patients underwent 1 of 3 soft tissue dissection techniques: myocutaneous flap, interfascial, and subfascial dissection techniques. Clinical and radiological assessments were performed upon discharge and at the 3- and 6-month follow-ups. We included 78 patients, with a mean age of 44.9 ± 16.3 years. Myocutaneous flap, interfascial, and subfascial dissections were performed in 34 (43%), 24 (30%), and 20 patients (25%), respectively. The myocutaneous flap method had the shortest opening (P = .001) and closure (P = .005) times; tenderness was more evident in this group than in the others (P = .05). The frontalis muscle was most affected in the interfascial dissection group (P = .05). The frontalis nerve function was similar in all groups after 6 months (P = .54). The incidence of temporomandibular joint dysfunction was highest in the myocutaneous flap group (29%). Decreased temporalis muscle thickness at the 6-month postoperative follow-up was most severe in the subfascial dissection group (12.6%), followed by the myocutaneous flap (11.9%) and interfascial dissection (9.9%) groups, with no significant difference (P = .85). Temporal hollowing was more prominent in the myocutaneous flap group (P = .03). Cosmetic satisfaction was highest in the interfascial dissection group, with no significant difference (P = .4). This study provides important information for neurosurgeons in weighing the benefits and risks of each technique for their patients.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Given the complex anatomy of the operative region and individual surgeon preferences, some techniques for soft tissue dissection before pterional craniotomy have gained more popularity than others. This prospective study used subjective and objective measurements to compare the functional, radiological, and aesthetic outcomes of 3 such dissection techniques.
METHODS
METHODS
This multicenter prospective cohort study included all patients who underwent elective pterional craniotomy between 2018 and 2020 at 3 centers in Riyadh, Saudi Arabia. All patients underwent 1 of 3 soft tissue dissection techniques: myocutaneous flap, interfascial, and subfascial dissection techniques. Clinical and radiological assessments were performed upon discharge and at the 3- and 6-month follow-ups.
RESULTS
RESULTS
We included 78 patients, with a mean age of 44.9 ± 16.3 years. Myocutaneous flap, interfascial, and subfascial dissections were performed in 34 (43%), 24 (30%), and 20 patients (25%), respectively. The myocutaneous flap method had the shortest opening (P = .001) and closure (P = .005) times; tenderness was more evident in this group than in the others (P = .05). The frontalis muscle was most affected in the interfascial dissection group (P = .05). The frontalis nerve function was similar in all groups after 6 months (P = .54). The incidence of temporomandibular joint dysfunction was highest in the myocutaneous flap group (29%). Decreased temporalis muscle thickness at the 6-month postoperative follow-up was most severe in the subfascial dissection group (12.6%), followed by the myocutaneous flap (11.9%) and interfascial dissection (9.9%) groups, with no significant difference (P = .85). Temporal hollowing was more prominent in the myocutaneous flap group (P = .03). Cosmetic satisfaction was highest in the interfascial dissection group, with no significant difference (P = .4).
CONCLUSION
CONCLUSIONS
This study provides important information for neurosurgeons in weighing the benefits and risks of each technique for their patients.
Identifiants
pubmed: 37815213
doi: 10.1227/ons.0000000000000929
pii: 01787389-990000000-00901
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
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