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J Neurol Surg B Skull Base 2016; 77(03): 265-270
DOI: 10.1055/s-0035-1568872
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Interfascial Dissection for Protection of the Nerve Branches to the Frontalis Muscles during Supraorbital Trans-Eyebrow Approach: An Anatomical Study and Technical Note

Roger Neves Mathias
1   Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
2   Department of Neurosurgery, State University of Campinas, Campinas, Brazil
,
Stefan Lieber
1   Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Paulo Henrique Pires de Aguiar
3   Department of Clínical Surgery, State University of Londrina, Paraná, Brazil
,
Marcos Vinícius Calfat Maldaun
2   Department of Neurosurgery, State University of Campinas, Campinas, Brazil
,
Paul Gardner
1   Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Juan C. Fernandez-Miranda
1   Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

31 August 2015

14 October 2015

Publication Date:
30 November 2015 (online)

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Abstract

Introduction Preservation of the temporal branches of the facial nerve during anterolateral craniotomies is important. Damaging it can inflict undesirable cosmetic defects to the patient. The supraorbital trans-eyebrow approach (SOTE) is a versatile keyhole craniotomy but still has a high rate of frontalis muscle (FM) palsy.

Objective Anatomical study to implement the interfascial dissection during the SOTE to preserve the nerves to the FM.

Methods Slight modification of the standard technique of the SOTE was performed in 6 cadaveric specimens (12 sides).

Results Distal rami to the FM were exposed. The standard “u—shape” incision of the FM can cross over the nerves. Alternatively, an “l-shape” incision was performed until the superior temporal line (STL). An interfascial dissection was performed near to the STL and the interfascial fat pad was used as a protective layer for the nerves.

Conclusion Various pathologies can be addressed with the SOTE. In the majority of the cases the cosmetic results are good, but FM palsy remains a drawback of this approach. The interfascial dissection may be used in an attempt to prevent frontalis rami palsy.

Keywords

supraorbital trans-eyebrow approach - interfascial dissection - frontalis muscle palsy - nerve protection
 

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