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pterional_craniotomy

Pterional craniotomy

Frontotemporal craniotomy, also known as “pterional craniotomy” (PC), provides an optimal microscopic exposure and a wide open working space for manipulation of intracranial structures, and it has been widely used in the field of neurosurgery for treatment of lesions in the anterior and posterior circulations 1).

Other frontotemporal craniotomies derived from the pterional 2) 3) and supraorbital 4) craniotomies, as are the combined epi- and subdural approach with anterior clinoid removal 5) 6) and the orbitozygomatic extension of the pterional craniotomy 7) 8).

The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes.

The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap.

see minipterional craniotomy.

Complications

Temporal hollowing occurs to varying degrees after pterional craniotomy. The most common cause of temporal hollowing is a bone defect of the pterional and temporal regions due to the resection of the sphenoid ridge and temporal squama for adequate exposure without overhang. The augmentation of such bony defects is important in preventing craniofacial deformities and postoperative hollowness. Temporal cranioplasty has been performed using a range of materials, such as acrylics, porous polyethylene, bone cement, titanium, muscle flaps, and prosthetic dermis. These methods are limited by the risk of damage to adjacent tissue and infection, a prolonged preparation phase, the possibility of reabsorption, and cost inefficiency. We have developed a method of temporal augmentation using a calvarial onlay graft as a single-stage neurosurgical reconstructive operation in patients requiring craniotomy. In this report, we describe the surgical details and review our institutional outcomes. The patients were divided into pterional craniotomy and onlay graft groups. Clinical temporal hollowing was assessed using a visual analog scale (VAS). Temporal soft tissue thickness was measured on preoperative and postoperative computed tomography (CT) studies. Both the VAS and CT-based assessments were compared between the groups. Our review indicated that the use of an onlay graft was associated with a lower VAS score and left-right discrepancy in the temporal contour than were observed in patients undergoing pterional craniotomy without an onlay graft 9).

Videos

Left pterional craniotomy for thrombectomy and clipping of ruptured left MCA giant aneurysm

1)
Kang HJ, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG. Comparative analysis of the mini-pterional and supraorbital keyhole craniotomies for unruptured aneurysms with numeric measurements of their geometric configurations. J Cerebrovasc Endovasc Neurosurg. 2013 Mar;15(1):5–12.
2)
Yasargil MG: Microneurosurgery. Stuttgart: Georg Thieme, 1984, Vol I
3)
Yasargil MG, Fox JL, Ray MW: The operative approach to aneurysms of the anterior communicating artery, in Krayenbül H (ed): Advances and Technical Standards in Neurosurgery. Wien: Springer-Verlag, 1975, Vol 2, pp 114–170
4)
Jane JA, Park TS, Pobereskin LH, et al: The supraorbital approach: technical note. Neurosurgery 11:537–542, 1982
5)
Dolenc VV: A combined epi-and subdural direct approach to carotidophthalmic artery aneurysms. J Neurosurg 62:667–672, 1985
6)
Dolenc VV, Yasargil MG: Anatomy and Surgery of the Cavernous Sinus. Wien: Springer-Verlag, 1989
7)
Fujitsu K, Kiwabara T: Zygomatic approach for lesions in the interpeduncular cistern. J Neurosurg 62:340–343, 1985
8)
Hakuba A, Liu S, Nishimura S: The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol 26: 271–276, 1986
9)
Kim YS, Yi HS, Kim HK, Han YS. Effectiveness of Temporal Augmentation Using a Calvarial Onlay Graft during Pterional Craniotomy. Arch Plast Surg. 2016 Mar;43(2):204-209. Epub 2016 Mar 18. PubMed PMID: 27019813.
pterional_craniotomy.txt · Last modified: 2016/03/29 11:39 (external edit)