J Cerebrovasc Endovasc Neurosurg.  2022 Mar;24(1):16-23. 10.7461/jcen.2021.E2021.07.001.

Cosmetic outcome after electrocautery versus non-electrocautery dissection of the temporalis muscle for pterional craniotomy

• Lee SW
• Lee YS
• Lee MS
• Suh SJ
• Lee JH
• Kim JW

• KMID: 2527591
• DOI: http://doi.org/10.7461/jcen.2021.E2021.07.001

Abstract

Objective
Despite the usefulness of pterional craniotomy (PC), its cosmetic outcome is questionable. Electrocautery (EC) causes injuries to adjacent structures, and it could be a factor that affects the cosmetic outcome. Evaluation of cosmetic outcome is difficult because it is often determined by patient’s subjective criteria. The objective of this study is to compare the cosmetic outcome after EC versus non-electrocautery (NEC) dissection of the temporalis muscle for PC by analyzing long-term follow-up data determined from both physician and patient’s aspects.
Methods
Patients at follow-ups between January 2014 and April 2021 after PCs were enrolled. The keyhole (KH) site, the inferior margin of the temporal line of the frontal bone (ITL), the mid-temporal (mid-T) area, and the posterior incision line (PIL) were inspected by a physician to check the presence of depressions. Patient’s cosmetic satisfaction was categorized into satisfactory, intermediate, or unsatisfactory by a survey. The presence of osteolysis was checked from the radiological images. Patients were classified into two groups; one with EC dissection and another with NEC retrograde dissection using a double-ended dissector.
Results
The incidences of depression at the mid-T area and osteolysis were higher in the EC group (p=0.001, p＜0.001). The percentage of satisfactory cosmetic outcome was lower in the EC group (p=0.002). The presences of depression at the mid-T area and osteolysis were related with lower rate of satisfactory outcomes (p＜0.001, p＜0.001).
Conclusions
NEC dissection causes less destruction to adjacent structures and brings better cosmetic outcome after PC.

Keyword

Cosmetic outcome; Electrocautery; Osteolysis; Pterional; Temporalis

Figure

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  Fig. 1. A photograph of a patient after pterional craniotomy shows a focal depression at the keyhole site (black arrow), a linear depression along the inferior margin of the temporal line of the frontal bone (white arrowheads), and a diffuse mid-temporal hollow (asterisk).

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  Fig. 2. The illustration indicates the locations of depression after pterional craniotomy (red dotted line), which are the keyhole site (black shaded area), the inferior margin of the temporal line of the frontal bone (white arrowheads), the mid-temporal area (blue shaded area), and the posterior incision line (blue dotted line) where the temporalis muscle is cut.

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  Fig. 3. Intraoperative photographs demonstrate the procedures of the temporalis reconstruction after non-electrocautery dissection of temporalis muscle. (A) After fixation of the bone flap, the keyhole site is repaired using temporal mesh floating technique. (B) The antero-inferior portion of the temporalis muscle is sutured over the temporal mesh. (C, D) The edge of the temporalis fascia and muscle is sutured onto the original attachment site through the mini-holes made on the temporal line of the frontal bone. Note that retrograde dissection using double-ended dissector leaves no remnant marks of soft tissues on the skull.

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