THE MINIPTERIONAL CRANIOTOMY

TLDR

The study aims to describe a modified pterional craniotomy (MPT) and compare its anatomical exposure to the standard pterional approach (PT). Using a computerized tracking system, robotic microscope, and image‑guidance, the authors compared the area, angular exposure, and anatomical limits of MPT and PT on eight cadaver sides and reported three recent clinical cases. The MPT offers comparable surgical exposure to PT, with no significant differences in area or angular exposure, and provides advantages such as reduced tissue trauma, less bone removal, shorter operative time, and better cosmetic results.

Abstract

OBJECTIVE To describe a modification of the pterional approach (PT), the minipterional craniotomy (MPT), and compare the anatomic exposure provided by these two approaches. METHODS The anatomic exposure offered by the MPT and PT were compared in eight sides of cadaver heads using a computerized tracking system, a robotic microscope, and an image-guidance system. The area of surgical exposure, angular exposure, and anatomic limits of each craniotomy were evaluated. Three recently operated clinical cases (EGF) are also reported. RESULTS There were no statistical differences in the total area of surgical exposure between the two craniotomies (PT, 1524.7 ± 305 mm2; MPT, 1469.7 ± 380.3 mm2; P > 0.05) or among the ipsilateral, middle, and contralateral components of the area (P > 0.05). There were no differences in angular exposure along the longitudinal and transverse axis angles for the three selected targets, the bifurcations of internal carotid and middle cerebral arteries, and the anterior communicating artery (P > 0.05). Except for the distal portion of the operculoinsular compartment of the sylvian fissure, no significant differences in the limits of the surgical exposure through the PT and MPT were apparent on the image-guidance system. CONCLUSION The MPT craniotomy provides comparable surgical exposure to that offered by the PT. The advantages of the MPT include reduction of tissue trauma and bony removal, a decrease in surgical time, and improved cosmetic outcomes.