"The Double S" Technique: Subfascial Dissection and Temporalis Muscle Splitting to Prevent Cerebrospinal Fluid Leak and Maximize Surgical Exposure

• Published in: The Journal of craniofacial surgery Vol. 34; no. 3; p. 1067
• Main Authors: Graziano, Francesca, Scalia, Gianluca, Paolini, Federica, Umana, Giuseppe E, Maugeri, Rosario, Iacopino, Domenico G, Nicoletti, Giovanni F
• Format: Journal Article
• Language: English
• Published: United States 01.05.2023
• Subjects: Cerebrospinal Fluid Leak - prevention & control; Cerebrospinal Fluid Leak - surgery; Craniotomy - methods; Humans; Postoperative Complications - surgery; Retrospective Studies; Temporal Muscle - surgery
• ISSN: 1536-3732
• DOI: 10.1097/SCS.0000000000009051

Middle cranial fossa surgery commonly is approached either performing a subtemporal or a pterional craniotomy. To maximize a basitemporal region exposure, an adjunctive bone drilling could be required. In these cases, a watertight dura and temporalis muscle closure are mandatory. To describe a modified temporalis muscle dissection in middle cranial fossa surgery to increase basitemporal region exposure while assuring a safe and effective closure thus avoiding cerebrospinal fluid (CSF) leakage. A total of 8 patients have been enrolled. Five pterional and 3 subtemporal approaches were performed. In all cases, the novel subfascial muscle dissection and temporalis muscle splitting technique named "the double S technique," was performed to cut up the temporal muscle. In all cases, a subgaleal drainage was used and removed within 48 hours. No cases of postoperative CSF leak or hematoma collection were reported. The double S technique is a safe and effective alternative to enhance the basitemporal region exposure while avoiding the potential, common risk of CSF leak.