title: Interfascial Dissection for Protection of the Nerve Branches to the Frontalis Muscles during Supraorbital Trans-Eyebrow Approach: An Anatomical Study and Technical Note.
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.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; Department of Neurosurgery, State University of Campinas, Campinas, Brazil.
authors.forename: Roger Neves
authors.initials: RN
authors.lastname: Mathias
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lieber
authors.affiliation: Department of Clínical Surgery, State University of Londrina, Paraná, Brazil.
authors.forename: Paulo Henrique Pires
authors.initials: PH
authors.lastname: de Aguiar
authors.affiliation: Department of Neurosurgery, State University of Campinas, Campinas, Brazil.
authors.forename: Marcos Vinícius Calfat
authors.initials: MV
authors.lastname: Maldaun
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernandez-Miranda
keywords: frontalis muscle palsy; interfascial dissection; nerve protection; supraorbital trans-eyebrow approach