Objective To compare the effects of three temporalis muscle dissection techniques—myocutaneous (MC), interfascial (IF), and subfascial (SF)—on surgical freedom during the pterional approach. Methods Eight cadaveric heads were dissected bilaterally (16 sides). The MC, IF, and SF techniques were compared in terms of temporal lobe surface area, surgical freedom volume, and horizontal and vertical angles of attack at eight predefined target points. Measurements were obtained using Cartesian coordinates acquired with a frameless stereotactic navigation system and analyzed using mathematical modeling. Results The mean temporal lobe surface areas were 14 ± 1 cm 2 , 18 ± 1 cm 2 , and 20 ± 1 cm 2 for the MC, IF, and SF techniques, respectively. Both IF and SF produced significantly greater temporal lobe exposure than MC (p < 0.001), with SF exceeding IF (mean difference: 2.2 ± 0.3 cm 2 , p < 0.001). The subfascial technique also allowed greater posteroinferior mobilization of the temporalis muscle (1 ± 0.2 cm) compared with the interfascial technique. The MC technique consistently demonstrated the lowest surgical freedom volumes and the narrowest horizontal and vertical angles of attack at the predefined target points (p < 0.05). Compared with IF, the SF technique provided greater surgical freedom volumes and wider horizontal angles of attack across all target points (p < 0.05), whereas vertical angles did not differ significantly. Conclusions Subfascial temporalis muscle dissection was associated with greater surgical freedom and temporal lobe exposure during the pterional approach and may be advantageous when wider operative corridors are required.
Hasimoglu et al. (Fri,) studied this question.