Novel Hybrid Technique for Preservation of Frontal Branch of Facial Nerve: Subgaleal Preinterfascial Dissection

OBJECTIVE: The pterional approach is the workhorse of skull-base neurosurgery, which allows virtual access to any intracranial lesion around the circle of Willis. Pre -serving the frontotemporal branch of the facial nerve and conserving the temporal muscle's symmetry are funda-mental objectives besides the access that can be obtained through this versatile neurosurgical technique. This manuscript proposes a subgaleal preinterfascial dissec-tion, a novel hybrid technique that provides advantages of previously described temporal muscle dissection tech- -iques while preserving the integrity of facial nerve branches and the unobstructed broad pterional region. We describe the subgaleal preinterfascial dissection as a safe and simple to technique to achieve preservation of the facial nerve frontal branches during anterolateral approaches. -METHODS: Two cadaveric heads were skillfully dissected and studied to perform a proper subgaleal pre-interfascial dissection on both sides of each cadaver. Af-terward, the same technique was employed in 108 patients during a pterional approach for different neurosurgical diseases, with a postoperative follow-up of 6 months. -RESULTS: None of the 108 patients presented post-operative frontotemporal branch palsy during postoperative follow-up. Likewise, no complications related to the pro-posed technique were present.-CONCLUSIONS: The subgaleal preinterfascial dissec-tion is a reliable, safe technique that may be employed during a pterional approach with an unobstructed surgical view and excellent cosmetic and functional results, pre -serving the frontotemporal branch of the facial nerve.