Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures.

Background: I developed a modified pterional craniotomy technique which is less invasive for both the facial nerve and the temporalis muscle.

Methods: The keys to this procedure are subfascial dissection and reflection of the temporalis fascia without interfascial dissection, and posterior displacement of the temporalis muscle without muscular incision. The limited exposure from the bulky temporalis muscle can be avoided with this procedure. A small cuff of the fascia-periostium complex is left on a free bone flap along the superior temporal line to facilitate the subsequent muscle closure.

Results: Since the facial nerve and temporalis muscle are not injured with this procedure, the functional and cosmetic results are satisfactory.

Conclusions: To reduce functional and cosmetic complications, and the cost of pterional craniotomy, I believe that my procedure is recommended.