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. 2024 Jan 16;166(1):11.
doi: 10.1007/s00701-024-05888-4.

'What's in a name', a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

Nicholas G Candy  1   2 , Jorn Van Der Veken  3 , Vera Van Velthoven  4
Affiliations

'What's in a name', a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

Nicholas G Candy et al. Acta Neurochir (Wien). .

Abstract

Background: The pterional or frontosphenotemporal craniotomy has stood the test of time and continues to be a commonly used method of managing a variety of neurosurgical pathology. Already described in the beginning of the twentieth century and perfected by Yasargil in the 1970s, it has seen many modifications. These modifications have been a normal evolution for most neurosurgeons, tailoring the craniotomy to the patients' specific anatomy and pathology. Nonetheless, an abundance of variations have appeared in the literature.

Methods: A search strategy was devised according to the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. To identify articles investigating the variations in the pterional approach, the following search terms were applied: (pterional OR minipterional OR supraorbital) AND (approach OR craniotomy OR technique).

Results: In total, 3552 articles were screened with 74 articles being read in full with 47 articles being included for review. Each article was examined according the name of the technique, temporalis dissection technique, craniotomy technique and approach.

Conclusion: This systematic review gives an overview of the different techniques and modifications to the pterional craniotomy since it was initially described. We advocate for the use of a more standardised nomenclature that focuses on the target zone to simplify the management approach to supratentorial aneurysms.

Keywords: Aneurysm surgery; Lateral supraorbital craniotomy; Minipterional craniotomy; Pterional craniotomy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart demonstrating the process of study selection
Fig. 2
Fig. 2
Schematic illustration demonstrating the anatomical locations of the described craniotomies. Each coloured line represents a different anatomical location for the reviewed craniotomies: Cyan, fronto-spheno-temporal; dark blue, fronto-spheno-zygomatic; pink, fronto-sphenoidal; yellow, frontal; orange, fronto-spheno-temporo-zygomatic; red, temporo-sphenoidal; purple, fronto-spheno-parieto-temporal
Fig. 3
Fig. 3
Proposal of how to apply the ‘inside-out’ concept for aneurysm surgery and a way to simplify the approach related nomenclature
See this image and copyright information in PMC

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