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KMID : 1037420060010010024
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Journal of Korean Skull Base Society
2006 Volume.1 No. 1 p.24 ~ p.29
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Surgical Techniques in the Two-Pieces Orbitopterional Craniotomy -Cosmetic consideration
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Hwang Sun-Chul
Kim Bum-Tae
Im Soo-Bin
Shin Won-Han
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Abstract
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Cosmetic problems after the orbitopterional craniotomy are big concerns caused by the injury to the temporalis muscle and more destructive resection of the orbit. This report describes the techniques to dissect the physiologic plane of the temporalis muscle and fascia and preserve the contour of orbit. Subfascial dissection of the temporalis muscle for the scalp reflection was applied to preserve the frontal branch of the facial nerve. The temporalis muscle was detached from the temporal fossa from the anterior to posterior and proximal to distal manner. The muscle was not incised vertically or cauterized. A usual pterional craniotomy was performed and then an orbital craniotomy was followed. The passing drill (#8TA11, Midas Rex) was used to cut the orbital rim. The first cut was made on the lateral to the supraorbital notch. The second cut was proximal to the frontozygomatic suture. Following, the orbital roof was thinned to 3 to 4 cm posteriorly with cutting drills. The drilling was connected to the cutting edges of the orbital rim and the superior orbital fissure. After dural closure, the bone flaps were fixed with a Neuroclip®. This technique has been used for the 21 adult patients (11 male and 10 female patients) to clip anterior communicating artery aneurysms. The thickness of the temporalis muscle was measured at 3 points before surgery and in 3 months after surgery. As a result, it provided a wide basal exposure for clipping aneurysms. There were no injuries to the frontal branch of facial nerve. The most vulnerable area of periorbita injuries was just distal to frontozygomatic suture. All the patients suffered from the periorbital swelling after operation, which was subsided around 5 days. The bulk of the temporalis muscle was not sinificantly reduced and the reduction of the muscle thickness was less than 10%. The rigid fixation of the orbital and pterional bone flaps could be achieved. Although orbitopterional craniotomy is to require extensive works, cosmetic results may be optimal if the physiologic dissection of the temporalis muscle and fascia and appropriate resection and fixation of orbital roof were performed.
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KEYWORD
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Orbitopterional, Craniotomy, Cosmetic techniques
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