Abstract:There are a number of different surgical approaches in middle cerebral artery (MCA) aneurysm surgery. Evolution from the classical pterional approach towards smaller modified approaches took place over the years. In the present report, we describe a new modified approach in the treatment of MCA aneurysms, which is almost exclusively subfrontal. A modified approach was used on three patients with MCA bifurcation aneurysms. Craniotomy was subfrontal and suprapterional with minimal dissection of the temporal musc… Show more
“…The second type of incision is curvilinear in shape and is either behind the hairline of the temporal fossa and forehead, on the hairline, or slightly anterior. There are 28 articles [ 2 , 7 , 8 , 12 , 15 , 17 , 22 , 31 , 32 , 35 , 36 , 39 – 43 , 45 , 51 , 58 – 60 , 70 , 75 , 77 – 79 , 81 , 85 ] that describe this type of skin incision. Two articles [ 3 , 38 ] describe a bicoronal incision, one article [ 53 ] describes question mark/hockey stick incision over the temporal fossa and forehead and another article [ 55 ] describes a W-shaped incision.…”
Section: Resultsmentioning
confidence: 99%
“…Three articles [ 41 , 77 , 78 ] describe an osteoplastic craniotomy. One article [ 75 ] describes a T-shaped incision with subperiosteal dissection of each limb, and another article [ 70 ] describes incising the muscle along the attachment to the STL and dissecting subperiosteally. Four articles [ 3 , 10 , 38 , 48 ] did not describe the method of temporalis dissection.…”
Section: Resultsmentioning
confidence: 99%
“…2 ). Nineteen articles [ 2 , 12 , 15 , 22 , 32 , 35 , 39 , 42 , 51 , 53 , 56 , 59 , 70 , 76 – 78 , 81 , 83 , 85 ] described a craniotomy that involved removing bone from the fronto-spheno-temporal area (cyan). Eight articles [ 1 , 6 , 20 , 25 , 31 , 38 , 48 , 79 ] described a craniotomy that involved removing bone from the fronto-spheno-zygomatic area (dark blue).…”
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.
“…The second type of incision is curvilinear in shape and is either behind the hairline of the temporal fossa and forehead, on the hairline, or slightly anterior. There are 28 articles [ 2 , 7 , 8 , 12 , 15 , 17 , 22 , 31 , 32 , 35 , 36 , 39 – 43 , 45 , 51 , 58 – 60 , 70 , 75 , 77 – 79 , 81 , 85 ] that describe this type of skin incision. Two articles [ 3 , 38 ] describe a bicoronal incision, one article [ 53 ] describes question mark/hockey stick incision over the temporal fossa and forehead and another article [ 55 ] describes a W-shaped incision.…”
Section: Resultsmentioning
confidence: 99%
“…Three articles [ 41 , 77 , 78 ] describe an osteoplastic craniotomy. One article [ 75 ] describes a T-shaped incision with subperiosteal dissection of each limb, and another article [ 70 ] describes incising the muscle along the attachment to the STL and dissecting subperiosteally. Four articles [ 3 , 10 , 38 , 48 ] did not describe the method of temporalis dissection.…”
Section: Resultsmentioning
confidence: 99%
“…2 ). Nineteen articles [ 2 , 12 , 15 , 22 , 32 , 35 , 39 , 42 , 51 , 53 , 56 , 59 , 70 , 76 – 78 , 81 , 83 , 85 ] described a craniotomy that involved removing bone from the fronto-spheno-temporal area (cyan). Eight articles [ 1 , 6 , 20 , 25 , 31 , 38 , 48 , 79 ] described a craniotomy that involved removing bone from the fronto-spheno-zygomatic area (dark blue).…”
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.
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