Anchoring temporalis muscle with intact fascial layer along superior temporal line in pterional craniotomy: A technical note

Manipulation of temporalis muscle during pterional and fronto-temporal approach poses major cosmetic and functional issue postoperatively. The temporalis muscle is secured in its normal position by using implants or leaving thin rim of muscle and fascia attached along superior temporal line. A pure tissue-based method of anchoring intact temporalis muscle precisely along the superior temporal line is described. Thirty consecutive cases of pterional or fronto-temporal craniotomy were performed by single surgeon. A subfascial dissection technique was used which exposes the transition zone of the frontal pericranium with the temporalis facia. It is then separated by sharp dissection along the superior temporal line wherein the muscle is attached. Temporalis muscle and fascia were repositioned during closure, precisely at their original anatomical location by passing multiple anchoring sutures along the free edge of muscle and fascia lying along superior temporal line. Temporalis muscle reattachment was achieved in all cases with good cosmesis and functional outcome without temporalis muscle related complications at 6 months follow up. Approximation of sutures running through free edge of temporalis muscle with intact fascia along superior temporal line from anterior to posterior direction restores muscle and the fascial layer into its original position. Avoidance of any potential dead space formation during surgical exposure prevents periorbital edema, or subgaleal collection post-operatively. This inexpensive technique avoids implant related complications altogether with good functional and aesthetic outcome. Comparative study is needed for establishing superiority of this procedure over other techniques in future.