Dysfunction of the temporalis muscle after pterional craniotomy for intracranial aneurysms. Comparative, prospective and randomized study of one flap versus two flaps dieresis

• Published in: Arquivos de neuro-psiquiatria Vol. 56; no. 2; pp. 200 - 205
• Main Authors: de Andrade Júnior, F C, de Andrade, F C, de Araujo Filho, C M, Carcagnolo Filho, J
• Format: Journal Article
• Language: English
• Published: Brazil Academia Brasileira de Neurologia - ABNEURO 01-06-1998
• Subjects: Craniotomy - adverse effects; Craniotomy - methods; Female; Humans; Incidence; Intracranial Aneurysm - surgery; Male; Middle Aged; Muscular Atrophy; NEUROSCIENCES; Prospective Studies; PSYCHIATRY; Surgical Flaps; Temporal Muscle - physiopathology; Temporomandibular Joint Disorders - epidemiology; pterional craniotomy; atrophy temporalis muscle; temporalis muscle; craniotomia pterional; surgical technique; aneurismas intracranianos; intracranial aneurysm; atrofia músculo temporal; complicações pós-operatórias; postoperative complications; técnica cirúrgica; músculo temporal; articulação temporomandibular; temporomandibularis joint
• ISSN: 0004-282X; 1678-4227; 0004-282X
• DOI: 10.1590/s0004-282x1998000200006

Patients with intracranial aneurysm(s) of the carotid artery territory, treated with pterional craniotomy, were prospectively and randomly addressed to one layer flap (n = 36) or myocutaneous (MC) versus two layers' dieresis (n = 32) or interfascial (IF). The study protocol included the patient's sex, age, area of craniotomy, time of flap dieresis and synthesis, time of bone dieresis and synthesis, the intracranial time, including dura mater dieresis and synthesis and time of flap retraction. Before and after surgery, the patients were evaluated with examination specially oriented to V and VII cranial nerves, bi-temporal diameter measurement, the symmetry of the temporal region, tempora-mandibularis joint (TMJ) movements and cranial CT scan. The evaluations of the TMJ dysfunctions were postoperative pain, movement limitations at mastication, occlusion, mouth aperture and lateral movements of the jaw. The statistical analysis showed that the incidence of pain at TMJ and moderate and severe temporalis muscle atrophy was observed, comparing MC and IF, and there were significant differences among these ones, being greater in IF group. We concluded that both techniques permit equivalent access to the studied intracranial aneurysm(s), and the atrophy of temporalis muscle, pain and movement limitations of the temporomandibularis joint were prevalent, worse and more long-lasting in two-layers flap dieresis than in one-layer flap dieresis.