The anterolateral transcranial approaches expose the suprasellar region via an anterolateral trajectory, usually through a transsylvian or unilateral subfrontal corridor. These generally include the pterional (frontotemporal), orbitozygomatic, and lateral supraorbital (frontolateral) approaches.
While all of these approaches typically use a curvilinear incision behind the hairline, the latter group of supraorbital approaches can also be performed with smaller eyebrow or eyelid incisions.
These are familiar approaches that provide a short route to the suprasellar region and are particularly useful for tumors that exhibit lateral extension into the sylvian fissure. Recently, Gerganov et al. reported excellent outcomes with an 87% rate of gross-total resection of extensive craniopharyngiomas using a more simple frontolateral craniotomy. While there are a variety of anterolateral approaches, we prefer the one-piece modified orbitozygomatic approach. This approach is a natural extension of the pterional approach which provides a more basal (inferior-to-superior) surgical trajectory, increases the corridor of exposure, shortens the distance to the target, and improves surgical freedom (maneuverability of instruments) while minimizing brain retraction 1).