18. 脳動脈瘤の手術におけるcosmetic craniotomy

抄録

The authors have devised a new cosmetic craniotomy in the surgery of intracranial aneurysms for the purpose of early recovery to the social activities of the patients.
The key procedures in the craniotomy are to cover the operative wound by the hair, to pre-serve the temporal branches of the facial nerve and to avoid bone defect.
The eyebrow is not shaved and the hair is shaved only up to 4 cm behind the hair line and 2cm above the zygomatic arch. For the protection of the temporal branches of the facial nerve, it is important to avoid any thermal effect on the branches by electrocautery and to retract the scalp, the galea aponeurotica, the frontal periosteum and the temporal fascia in a sheet so as to minimize the traction effect on the branches. The temporal muscle is bluntly dissected from the temporal bone and is posterolaterally retracted. A rhombic free bone flap is made and after the intracranial procedures on the aneurysm are completed, the bone flap is fixed by silk threads and bone defect is completely replaced with Bioresin. The temporal muscle is sutured at its anterior margin to soft tissues and its medial margin is fixed to the bone flap. Scalp is closed in layers.
The authors have experienced the cosmetic craniotomy on 60 cases and without any case with paralysis of the temporal branches of the facial nerve. There was no case with difficulty in mastication soon after the surgery but there were two cases with temporary difficulty in opening the mouth which was attributed to abnormal contracture of the temporal muscle.