Management of temporal muscle in anterior temporal lobectomy during fronto-temporal craniotomy

Objective Anterior temporal lobectomy and fronto-temporal craniotomy are the traditional surgical method for temporal lobe epilespy,in which management of temporal muscle is crucial.Any improper management of temporal muscle may result in the atrophy of post-operative temporal muscle.The study aims to put forward the surgical principles and techniques for the management of temporal muscle in fronto-temporal craniotomy according to our experiences and the anatomic study.Methods On the basis of anatomic study of fronto-temporal region and the literature review,the following surgical principles were put forward: firstly,during the incision and elevation of fronto-temporal scalp flap,the superficial temporal artery and the branches of facial nerves should be well preserved;secondly,preservation of temporal fascia attachment on the superior temporal line was helpful for the anatomic restoration of the temporal muscle;thirdly,retrograde dissection of the temporal muscle together with the temporal fascia was important;fourthly,wider stem of temporal muscle flap should be preserved and the transection of the muscle should be avoided;lastly,monopolar cautery was not suggested in the dissection of temporal muscle.Results Sixty-eight patients underwent the craniotomy according to the above-mentioned principles.Only 3 patients suffered the postoperative chewing ache in temporal region.No case of temporal muscle atrophy was found in 43 cases during 6 months to 2 years' follow-up.Conclusion Proper management of the temporal muscle and innervated nerves and arteries is helpful for the exposure and important for the prevention of complication,such as atrophy of temporal muscle.