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

• Published in: Journal of neurological surgery. Part B, Skull base Vol. 77; no. 3; pp. 265 - 270
• Main Authors: Mathias, Roger Neves, Lieber, Stefan, de Aguiar, Paulo Henrique Pires, Maldaun, Marcos Vinícius Calfat, Gardner, Paul, Fernandez-Miranda, Juan C.
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01.06.2016
• Subjects: Original Article; interfascial dissection; nerve protection; supraorbital trans-eyebrow approach; frontalis muscle palsy
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0035-1568872

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.