The Anatomy of Fibrofatty Adhesion and the Pterional Scalp Flap Opening Using the Suprafascial Dissection Technique

Authors

  • ภัคพนธ์ ยังสมิทธ์ หน่วยประสาทศัลยศาสตร์ ภาควิชาศัลยศาสตร์ คณะแพทยศาสตร์วชิรพยาบาล มหาวิทยาลัยนวมินทราธิราช
  • กิติพร ศรีอมรรัตนกุล หน่วยประสาทศัลยศาสตร์ ภาควิชาศัลยศาสตร์ คณะแพทยศาสตร์วชิรพยาบาล มหาวิทยาลัยนวมินทราธิราช

Keywords:

Suprafascial dissection, fibrofatty adhesion, frontotemporal branch of facial nerve, pterional craniotomy, pterional scalp flap

Abstract

Currently, the suprafascial technique for scalp opening at the pterion has gained popularity among the neurosurgical groups of Professor Hiroyasu Kamiyama and Rokuya Tanikawa in Japan. Understanding the anatomy of fibrofatty adhesion is crucial for performing surgery with this technique. Therefore, the author has compiled knowledge regarding fibrofatty adhesion in this article.

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References

Katsuno M, Tanikawa R, Miyazaki T, Ota N, Noda K, Izumi N, et al. Anterior temporal approach and extradural-temporopolar approach for the surgery of basilar bifurcation and posterior projecting carotid aneurysm. Jpn J Neurosurg. 2010;19:733-41.

Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, et al. Localization in the interpeduncular cistern as risk factors for the thalamoperforators’ ischemia, poor outcome, and oculomotor nerve palsy in patients with complex unruptured basilar apex aneurysm treated with neck clipping. World Neurosurg. 2015;84:475-82.

Takeuchi S, Tanikawa R, Tsuboi T, Noda K, Oda J, Miyata S, et al. Superficial temporal artery to proximal posterior cerebral artery bypass through the anterior temporal approach. Surg Neurol Int. 2015;6:95.

Yaşargil MG, Reichman MV, Kubik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. J Neurosurg. 1987;67(3):463-6. doi:10.3171/jns.1987.67.3.0463

Baucher G, Bernard F, Graillon T, Dufour H. Interfascial approach for pterional craniotomy: technique and adjustments to prevent cosmetic complications. Acta Neurochir (Wien). 2019;161(11):2353-7. doi:10.1007/s00701-019-04058-1

Coscarella E, Vishteh AG, Spetzler RF, Seoane E, Zabramski JM. Subfascial and submuscular methods of temporal muscle dissection and their relationship to the frontal branch of the facial nerve. Technical note. J Neurosurg. 2000;92(5):877-80. doi:10.3171/jns.2000.92.5.0877

Davidge KM, van Furth WR, Agur A, Cusimano M. Naming the soft tissue layers of the temporoparietal region: unifying anatomic terminology across surgical disciplines. Neurosurgery. 2010;67(3 Suppl Operative):ons120-ons130. doi:10.1227/01.NEU.0000383132.34056.61

Poblete T, Jiang X, Komune N, Matsushima K, Rhoton AL Jr. Preservation of the nerves to the frontalis muscle during pterional craniotomy. J Neurosurg. 2015;122(6):1274-1282. doi:10.3171/2014.10.JNS142061

Chaddad-Neto F, Campos Filho JM, Dória-Netto HL, Faria MH, Ribas GC, Oliveira E. The pterional craniotomy: tips and tricks. Arq Neuropsiquiatr. 2012;70(9):727-32. doi:10.1590/s0004-282x2012000900015

Horimoto C, Toba T, Yamaga S, Tsujimura M. Subfascial temporalis dissection preserving the facial nerve in pterional craniotomy--technical note. Neurol Med Chir (Tokyo). 1992;32(1):36-7. doi:10.2176/nmc.32.36

Salas E, Ziyal IM, Bejjani GK, Sekhar LN. Anatomy of the frontotemporal branch of the facial nerve and indications for interfascial dissection. Neurosurgery. 1998;43(3):563-9. doi:10.1097/00006123-199809000-00089

Spetzler RF, Lee KS. Reconstruction of the temporalis muscle for the pterional craniotomy. Technical note. J Neurosurg. 1990;73(4):636-7. doi:10.3171/ jns.1990.73.4.0636

Sriamornrattanakul K, Akharathammachote N, Wongsuriyanan S. Suprafascial dissection for pterional craniotomy to preserve the frontotemporal branch of the facial nerve with less temporal hollowing. Surg Neurol Int. 2021;12:559. doi:10.25259/SNI_999_2021

Baek RM, Heo CY, Lee SW. Temporal dissection technique that prevents temporal hollowing in coronal approach. J Craniofac Surg. 2009;20(3):748-51. doi:10.1097/scs.0b013e3181a2d745

Matic DB, Kim S. Temporal hollowing following coronal incision: a prospective, randomized, controlled trial. Plast Reconstr Surg. 2008;121(6):379e-85e. doi:10.1097/PRS.0b013e318170724c

Kucukguven A, Ulkir M, Bilgic Kucukguven M, Demiryurek MD, Vargel I. Defining a Preauricular Safe Zone: A Cadaveric Study of the Frontotemporal Branch of the Facial Nerve. Aesthet Surg J. 2021;41(4):398- 407. doi:10.1093/asj/sjaa232

Shin KJ, Shin HJ, Lee SH, Koh KS, Song WC. Surgical anatomy of the superficial temporal artery to prevent facial nerve injury during arterial biopsy. Clin Anat. 2018;31(4):608-13. doi:10.1002/ca.23033

Spiriev T, Ebner FH, Hirt B, et al. Fronto-temporal branch of facial nerve within the interfascial fat pad: is the interfascial dissection really safe?. Acta Neurochir (Wien). 2016;158(3):527-32. doi:10.1007/s00701-016-2711

Tayfur V, Edizer M, Magden O. Anatomic bases of superficial temporal artery and temporal branch of facial nerve. J Craniofac Surg. 2010;21(6):1945-7. doi:10.1097/SCS.0b013e3181f4ee6a

Yangsamit P, Sriamornrattanakul K, Akharathammachote N, Ruangchainikom M, Chentanez V, Oearsakul T. Anatomy of the fibrofatty adhesion related to the frontozygomatic process for suprafascial dissection of the pterional scalp flap: a cadaveric and clinical study. Asian J Neurosurg. 2025;20:590–6. doi: 10.1055/s-0045-1809326

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Published

2025-10-02

How to Cite

ยังสมิทธ์ ภ., & ศรีอมรรัตนกุล ก. (2025). The Anatomy of Fibrofatty Adhesion and the Pterional Scalp Flap Opening Using the Suprafascial Dissection Technique. Thai Journal of Neurological Surgery, 15(4), 138–144. retrieved from https://he05.tci-thaijo.org/index.php/TJNS/article/view/6698

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Review Articles