The “Agnes Fast”[*] Craniotomy: The Modified Pterional (Osteoplastic) Craniotomy

ABSTRACT

The “Agnes Fast” craniotomy is a fast and simple way of performing the pterional craniotomy while preserving the temporalis muscle, together with its fascia and bony attachment. Using this technique, the surgeon need not divide the temporalis muscle, separate it from its bony attachment, or perform an interfacial dissection. With a little practice, this craniotomy can be performed in less than 5 minutes and is highly recommended in emergent settings. The modified pterional craniotomy was performed in 10 cadaveric specimens, preserving the temporalis muscle with its attachment. An interfascial dissection was not performed while exposing the frontozygomatic process. The exposure gained, the length of the procedure, and the ease of application were recorded for all heads studied. In all heads studied, the Agnes Fast craniotomy was performed, with complete preservation of the temporalis muscle and its attachments. This procedure was performed quickly, with complete preservation of the fascial nerve and its branches. The muscle was put back in its natural place following the craniotomy. The Agnes Fast craniotomy offers a fast way of performing a pterional craniotomy while preserving the temporalis muscle, with its blood supply, neural innervation, bony attachment, and fascia intact. Replacing the muscle is also fast and simple and involves placement of two CranioFix (Aesculap, Inc., Center Valley, PA) holders to the bone, with no suture material. This approach does not limit the exposure gained and offers the same exposure as the “usual” pterional craniotomy.

KEYWORDS

Pterional craniotomy - temporalis muscle preservation - osteoplastic

1 Aganetha “Agnes Fast” Anderson (1883–1977) was a nurse known as “Florence Nightingale of Steinbach” and was born in 1883 in Canada. Agnes became a local hero in 1918 when she helped fight the Spanish flu epidemic in Steinbach. A local school was converted into a makeshift hospital where Agnes worked tirelessly from September to December in 1918. Her service and dedication saved many lives. Only one young woman was known to have died under her care. As the epidemic subsided in Steinbach, Agnes herself became ill. Eventually Agnes recovered and went on to finish her education, marry, and return to Steinbach, where she spent her retirement years.[1] The philosophy behind the “Agnes Fast” craniotomy encompasses this dedication, perfection, and prompt provision of care.

REFERENCES

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1 Aganetha “Agnes Fast” Anderson (1883–1977) was a nurse known as “Florence Nightingale of Steinbach” and was born in 1883 in Canada. Agnes became a local hero in 1918 when she helped fight the Spanish flu epidemic in Steinbach. A local school was converted into a makeshift hospital where Agnes worked tirelessly from September to December in 1918. Her service and dedication saved many lives. Only one young woman was known to have died under her care. As the epidemic subsided in Steinbach, Agnes herself became ill. Eventually Agnes recovered and went on to finish her education, marry, and return to Steinbach, where she spent her retirement years.[1] The philosophy behind the “Agnes Fast” craniotomy encompasses this dedication, perfection, and prompt provision of care.