Temporalis Muscle Dissection Techniques in the Pterional Approach: Quantitative Impact on Operative Corridor and Surgical Freedom.

OBJECTIVE

To compare the effects of 3 temporalis muscle dissection techniques-myocutaneous (MC), interfascial (IF), and subfascial (SF)-on surgical freedom during the pterional approach.

METHODS

Eight cadaveric heads were dissected bilaterally (16 sides). The MC, IF, and SF techniques were compared in terms of temporal lobe surface area, surgical freedom volume, and horizontal and vertical angles of attack at 8 predefined target points. Measurements were obtained using Cartesian coordinates acquired with a frameless stereotactic navigation system and analyzed using mathematical modeling.

RESULTS

The mean temporal lobe surface areas were 14 ± 1 cm2, 18 ± 1 cm2, and 20 ± 1 cm2 for the MC, IF, and SF techniques, respectively. Both IF and SF produced significantly greater temporal lobe exposure than MC (P < 0.001), with SF exceeding IF (mean difference: 2.2 ± 0.3 cm2, P < 0.001). The SF technique also allowed greater posteroinferior mobilization of the temporalis muscle (1 ± 0.2 cm) compared with the IF technique. The MC technique consistently demonstrated the lowest surgical freedom volumes and the narrowest horizontal and vertical angles of attack at the predefined target points (P < 0.05). Compared with IF, the SF technique provided greater surgical freedom volumes and wider horizontal angles of attack across all target points (P < 0.05), whereas vertical angles did not differ significantly.

CONCLUSIONS

SF temporalis muscle dissection was associated with greater surgical freedom and temporal lobe exposure during the pterional approach and may be advantageous when wider operative corridors are required.