PDF icon PDF herunterladen
Open Access
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1809326
Original Article

Anatomy of the Fibrofatty Adhesion Related to the Frontozygomatic Process for Suprafascial Dissection of the Pterional Scalp Flap: A Cadaveric and Clinical Study

Pakapon Yangsamit
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
,
Kitiporn Sriamornrattanakul
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
,
Nasaeng Akharathammachote
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
,
Thirawass Phumyoo 
2   Division of Anatomy, Department of Basic Medical Science, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
› Institutsangaben
› Weitere Informationen
Auch verfügbar aufeRef
  Lizenzen und Reprints
Preview

Abstract

Background

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.

Materials and Methods

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.

Results

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.

Conclusion

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.

Keywords

pterional craniotomy - pterional scalp flap - suprafascial dissection - frontotemporal branch of the facial nerve - facial nerve - fibrofatty adhesion

Author's Contribution

P.Y., K.S., N.A., and T.P. contributed to the conception and design, acquisition of data, analysis and interpretation of data, and drafting the article. : K.S. and N.A. critically revised the article. K.S. reviewed submitted version of the article and supervised the study.


Ethical Approval

The study was approved by the Institutional Review Board of the Faculty of Medicine Vajira Hospital. COA no. was 210/2567.




Publikationsverlauf

Artikel online veröffentlicht:
20. Mai 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India