The “Agnes Fast” Craniotomy: The Modified Pterional (Osteoplastic) Craniotomy

Ezer, Haim; Banerjee, Anirban; Shorter, Cedric; Nanda, Anil

doi:10.1055/s-0031-1275247

Cited by 10 publications

(5 citation statements)

References 12 publications

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“…The common reason for exclusion involved 21 articles [ 4 , 9 , 11 , 16 , 18 , 19 , 26 , 27 , 30 , 46 , 49 , 52 , 54 , 62 , 65 – 68 , 73 , 80 , 84 ] and is because the authors cited another article when describing the surgical technique. The other reasons for exclusion included as follows: one article [ 23 ] designing an approach to treat distal anterior cerebral artery aneurysms, one article [ 21 ] designed an approach that was not for cerebrovascular pathology, two articles [ 29 , 71 ] only described their technique being used in cadavers and two articles [ 24 , 28 ] only described a new subdural corridor without a novel craniotomy. Figure 1 contains the flowchart of study selection.…”

Section: Resultsmentioning

confidence: 99%

‘What’s in a name’, a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

Candy,

Van Der Veken,

Van Velthoven

2024

Acta Neurochir

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Background The pterional or frontosphenotemporal craniotomy has stood the test of time and continues to be a commonly used method of managing a variety of neurosurgical pathology. Already described in the beginning of the twentieth century and perfected by Yasargil in the 1970s, it has seen many modifications. These modifications have been a normal evolution for most neurosurgeons, tailoring the craniotomy to the patients’ specific anatomy and pathology. Nonetheless, an abundance of variations have appeared in the literature. Methods A search strategy was devised according to the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. To identify articles investigating the variations in the pterional approach, the following search terms were applied: (pterional OR minipterional OR supraorbital) AND (approach OR craniotomy OR technique). Results In total, 3552 articles were screened with 74 articles being read in full with 47 articles being included for review. Each article was examined according the name of the technique, temporalis dissection technique, craniotomy technique and approach. Conclusion This systematic review gives an overview of the different techniques and modifications to the pterional craniotomy since it was initially described. We advocate for the use of a more standardised nomenclature that focuses on the target zone to simplify the management approach to supratentorial aneurysms.

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Section: Resultsmentioning

confidence: 99%

‘What’s in a name’, a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

Candy,

Van Der Veken,

Van Velthoven

2024

Acta Neurochir

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“…Temporal atrophy is caused by traction or compression of the temporalis muscle, as well as damage to the temporal arteries 16 . Ezer et al 6 described a modified osteoplastic pterional craniotomy that preserved the temporalis fascia on the bone rather than dissecting it, preventing vascular supply loss and temporal atrophy. We used a similar technique in our patients and supported the existing data with our findings.…”

Section: Discussionmentioning

confidence: 99%

“…A modification to this technique includes performing an osteoplastic craniotomy, which creates a pedicled musculo-osteocutaneous flap 4 . Some surgeons prefer calvarial bone grafts during surgery, whereas others prefer osteoplastic craniotomy 4–8 . Both techniques can result in temporalis muscle atrophy, which can cause functional and cosmetic issues.…”

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confidence: 99%

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Effects of Pterional and Osteoplastic Craniotomy on Temporalis Muscle and Calvarial Bone Graft Atrophy

Kalemci,

Kizmazoglu,

Karabay

et al. 2023

Journal of Craniofacial Surgery

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This study aims to compare the effects of osteoplastic craniotomy on temporalis muscle and bone graft atrophy in patients operated on with a pterional approach to the standard technique. Patients operated on for an intracranial aneurysm with a pterional approach between 2014 and 2018 were studied. Following the exclusion criteria, 36 patients were included in this retrospective study. Temporalis muscle volume and bone graft volume were calculated. The volumes were compared from preoperative and postoperative computed tomography images for temporalis muscle and from early and late postoperative computed tomography images for the bone graft. The osteoplastic craniotomy group (group I) had 17 patients, and the standard craniotomy group had 19 patients (group II). Temporalis muscle volume and bone graft volume decreased statistically significantly in group II after surgery. However, no significant volume difference was found in group I measurements. When compared with the standard technique, osteoplastic craniotomy reduces the likelihood of postoperative temporalis muscle and bone graft atrophy in patients undergoing pterional craniotomy. As a result, the patients’ cosmetic and functional well-being is improved.

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“…The craniotomy is then performed form a burr hole placed anteriorly and superiorly to the STL, encircling the TM and ending at the posterior zygomatic root. The final osteotomy is carried under the subperiostal tunnel and finally the osteoplastic flap is reflected anteroinferiorly, hinged on the frontozygomatic attachment of the TM 18-20 .…”

Section: The Lateral Approaches: Principles and Highlightsmentioning

confidence: 99%

Surgery of the lateral skull base: a 50-year endeavour

Zanoletti¹,

Mazzoni²,

Martini³

et al. 2019

Acta Otorhinolaryngol Ital

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SUMMARY Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

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The “Agnes Fast” Craniotomy: The Modified Pterional (Osteoplastic) Craniotomy

Cited by 10 publications

References 12 publications

‘What’s in a name’, a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

‘What’s in a name’, a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

Effects of Pterional and Osteoplastic Craniotomy on Temporalis Muscle and Calvarial Bone Graft Atrophy

Surgery of the lateral skull base: a 50-year endeavour

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