{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:00:04Z","timestamp":1786449604169,"version":"build-2736575974"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Although a supraorbital keyhole approach utilizing an eyebrow incision and supraorbital minicraniotomy is one of the most commonly used keyhole approaches for treating cerebral aneurysms, the risk of frontalis muscle palsy due to an injury of the frontal branch of the facial nerve remains a serious drawback to a supraorbital keyhole approach as a minimally invasive surgical technique. Therefore, the authors attempted to evaluate the risk of frontalis muscle palsy by mapping the frontal nerve branch in the lower forehead using a nerve conduction study in individual patients.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Percutaneous mapping of the frontal nerve branch was performed preoperatively on 52 patients who underwent supraorbital keyhole approaches for aneurysmal clipping. The maximal compound muscle action potentials (CMAPs) in the lower forehead were observed at 5 points along a laterally inclined line angled 30\u00b0 from the midpupillary line, in which the points were 1.0, 1.5, 2.0, 2.5, and 3.0 cm as measured from the supraorbital margin.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Severe frontalis muscle palsy was observed in 11 patients (21.2%), yet recovery occurred 2\u20135 months after surgery. No patients experienced permanent palsy. The incidence of severe palsy was 7.4% in those patients showing clear CMAPs with a high location (exclusively at 2.0, 2.5, or 3.0 cm), 14.3% in those with a bimodal distribution, 40.0% in those with a low location (exclusively at 1.5 cm), and 83.3% in those with an extremely low location (exclusively at 1.0 cm).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Percutaneous mapping of the frontal branch of the facial nerve using a nerve conduction study can be used to assess the risk of postoperative frontalis muscle palsy following a supraorbital keyhole approach. The patients with the highest risk of postoperative palsy showed a clear CMAP exclusively at 1.0 cm along the inclined line measured from the supraorbital margin.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.1.jns121525","type":"journal-article","created":{"date-parts":[[2013,2,22]],"date-time":"2013-02-22T15:28:19Z","timestamp":1361546899000},"page":"1114-1119","source":"Crossref","is-referenced-by-count":31,"title":["Preoperative percutaneous mapping of the frontal branch of the facial nerve to assess the risk of frontalis muscle palsy after a supraorbital keyhole approach"],"prefix":"10.3171","volume":"118","author":[{"given":"Jaechan","family":"Park","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-du","family":"Jung","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine, Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Hun","family":"Kang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So-Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine, Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns121525","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/BF01400667","article-title":"Preservation of the temporal branch of the facial nerve in pterional-transzygomatic craniotomy","volume":"128","author":"Ammirati","year":"1994"},{"key":"b2-jns121525","series-title":"Arch Otolaryngol","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1001\/archotol.1984.00800290041009","article-title":"Surgical anatomy of the extraparotid distribution of the facial nerve","volume":"110","author":"Bernstein","year":"1984"},{"key":"b3-jns121525","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1080\/02688690701601521","article-title":"Supraorbital microcraniotomy for acute aneurysmal subarachnoid haemorrhage: results of first 50 cases","volume":"22","author":"Brydon","year":"2008"},{"issue":"5","key":"b4-jns121525","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.3171\/foc.2004.16.5.2","article-title":"Pathophysiology of peripheral nerve injury: a brief review","volume":"16","author":"Burnett","year":"2004"},{"key":"b5-jns121525","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1007\/s00701-009-0205-9","article-title":"Is eyebrow approach suitable for ruptured anterior circulation aneurysms on early stage: a prospective study at a single institute","volume":"151","author":"Chen","year":"2009"},{"key":"b6-jns121525","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1097\/00006534-197311000-00013","article-title":"Surgical anatomy of the facial nerve, as related to ancillary operations in rhytidoplasty","volume":"52","author":"Correia","year":"1973"},{"key":"b7-jns121525","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"877","DOI":"10.3171\/jns.2000.92.5.0877","article-title":"Subfascial and submuscular methods of temporal muscle dissection and their relationship to the frontal branch of the facial nerve. 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