The Effect of Temporal Muscle Suspension of Temporal Hollowing

The pterional approach is an indicated neurosurgical approach commonly used for anterior
circular aneurysms, suprasellar lesions, and medial sphenoid wing tumors (1,2). A curvilinear
incision from the midline widows peak and extending laterally to 1 cm anterior to the tragus
of the ear, terminating within a skin crease, with preservation of the superficial temporal
artery if possible. The temporalis fascia is encountered and divided. Either the entire
temporalis muscle can be elevated or a cuff of temporalis muscle can be left on the cranium
to facilitate closure and suspend the temporalis muscle. Subperiosteal dissection of the
muscle is performed and the craniotomies are then accomplished.

Reconstruction of the pterional approach can be accomplished with bony fixation of the bone
flap. However, the TMS can be performed by:

1. Resuspension of the temporalis muscle to the cuff of muscle left on the temporal crest
or

2. Suturing the temporalis muscle directly to one of the bone plates that is used to for
fixation.

The purpose of this prospective study is see if traditional techniques to the closure and
temporal muscle suspension (TMS) after the pterional approach will show any differences in
post-operative temporal hollowing (TH).

Inclusion Criteria:

- This study will include all patients over the age of 18 years who qualify for a
pterional approach for their neurosurgical pathology.

Exclusion Criteria:

- Excluded patients will be protected populations, such as inmates or children. Patients
will not be excluded on the basis of pregnancy.