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Pterional Craniotomy

Last Updated: June 7, 2019

Pterional Craniotomy: Improving the Efficiency of Exposure

General Considerations

The pterional or frontotemporal craniotomy is the workhorse of the supratentorial approaches. Because of its simplicity, flexibility, efficiency, and familiarity to neurosurgeons, this corridor is the most commonly used surgical route to lesions along the anterior and middle skull base.

I use the extended pterional approach, defined as a standard pterional craniotomy supplemented and expanded by

  1. Osteotomy along the lateral sphenoid wing to the level of the superior orbital fissure
  2. Drilling along the roof of the orbit to flatten its surface.
  3. If necessary, roungering temporal squama towards the floor of the middle fossa. 

These modifications provide unobstructed operative working angles toward the p...