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Review
. 2022 Mar 21;92(S4):e2021346.
doi: 10.23750/abm.v92iS4.12775.

Pterional Approach

Sabino Luzzi  1 , Alice Giotta Lucifero  2 , Nunzio Bruno  3 , Matias Baldoncini  4 , Alvaro Campero  5 , Renato Galzio  6
Affiliations
Review

Pterional Approach

Sabino Luzzi et al. Acta Biomed. .

Abstract

The pterional approach is a workhorse in neurosurgery, to the point where perfect knowledge of its execution is essential in neurosurgical daily practice. The pterional transsylvian corridor is used to treat aneurysms involving anterior circulation, basilar apex, the proximal segment of the superior cerebellar and posterior cerebral artery, arteriovenous malformations and cavernous hemangiomas of the basal forebrain, anterior and middle skull base tumors, gliomas of the frontal, parietal, and temporal opercula, insula, mediobasal temporal region, cerebral peduncles, interpeduncular fossa, and also orbital lesions. We herein overview the core technique and variations of the pterional approach aimed at broadening surgical freedom and decreasing the risk of approach-related complications.

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Conflict of interest statement

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article

Figures

Figure 1.
Figure 1.
Surgical position (A), skin mark (B), and incision (C). (D) Hemostasis of the skin flap with Raney clips. (E-I) Preparation of the galea-pericranium flap; (J-N) Incision of the superficial temporal fascia, temporalis muscle, and deep temporal fascia (submuscular technique), and retrograde subperiosteal dissection of the deep temporalis fascia according to Oikawa’s technique. (O) Identification of the sutures of the pterional region and drawing of the bone flap. (P) The first and second burr-hole is placed just above the McCarty keyhole and above the posterior root of the zygoma, respectively. (Q) Partial drilling of the lateral third of the greater sphenoid wing before completing the craniotomy. (R) Frontotemporal bone flap.
Figure 2.
Figure 2.
(A-C) left frontotemporal craniotomy and bone flap. Exposure of the sphenoidal part of the sylvian fissure (blue area) before (D) and after (E) drilling of the lateral third of the greater sphenoid wing. Splitting of the sylvian fissure (F) and intradural exposure of optico-carotid complex (G), lamina terminalis (H), anterior cerebral artery (I), Liliequist’s membrane (J), posterior communicating, and posterior cerebral artery (K). (L) Osteosynthesis of the bone flap with titanium low profile burr-hole covers, mini plates, and self-screwing unicortical screws.
Figure 3.
Figure 3.
(A-C) Illustrative examples of good functional and cosmetic outcomes of three randomly selected patients of the patients’ cohort.
Figure 4.
Figure 4.
(A) Pre-operative 3D CT-angiography. Anterior (B) and lateral (C) projection digital subtraction angiography (DSA) of the right internal carotid artery (ICA). Anterior (D) and lateral (E) projection DSA of the left ICA. Clipping of the aneurysm of the left middle cerebral artery (MCA) bifurcation (F-G), left posterior communicating artery (PCoA) (H), left anterior choroidal artery (I), right PCoA ( J), and right M1 segment MCA (K) aneurysm. (L) Post-operative 3D CT-angiography. Anterior (M) and lateral (N) projection DSA of the right ICA. Anterior (O) and lateral (P) projection DSA of the left ICA.
See this image and copyright information in PMC

References

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