Comparative anatomical analysis between the minipterional and supraorbital approaches

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Keyhole approaches, namely the minipterional approach (MPTa) and the supraorbital approach (SOa), are alternatives to the standard pterional approach to treat lesions located in the anterior and middle cranial fossae. Despite their increasing popularity and acceptance, the indications and limitations of these approaches require further assessment. The purpose of the present study was to determine the differences in the area of surgical exposure and surgical maneuverability provided by the MPTa and SOa.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The areas of surgical exposure afforded by the MPTa and SOa were analyzed in 12 sides of cadaver heads by using a microscope and a neuronavigation system. The area of exposure of the region of interest and surgical freedom (maneuverability) of each approach were calculated.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The area of exposure was significantly larger in the MPTa than in the SOa (1250 ± 223 mm<jats:sup>2</jats:sup> vs 939 ± 139 mm<jats:sup>2</jats:sup>, p = 0.002). The MPTa provided larger areas of exposure in the ipsilateral and midline compartments, whereas there was no significant difference in the area of exposure in the contralateral compartment. All targets in the anterior circulation had significantly larger areas of surgical freedom when treated via the MPTa versus the SOa.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The MPTa provides greater surgical exposure and better maneuverability than that offered by the SOa. The SOa may be advantageous as a direct corridor for treating lesions located in the contralateral side or in the anterior cranial fossa, but the surgical exposure provided in the midline region is inferior to that exposed by the MPTa.</jats:p></jats:sec>

Supraorbital and mini-pterional keyhole craniotomies for brain tumors: a clinical and anatomical comparison of indications and outcomes in 204 cases

“…Martínez-Pérez et al showed that, for aneurysm surgery, both the area of exposure and surgical freedom afforded by the MP approach were statistically greater than those provided by SO craniotomy. 19 However, in their analysis, SO craniotomy did not extend laterally to the superior temporal line. Another study by the same group compared the MP approach with an "extended SO" approach with a burr hole at the keyhole; this modification is essentially the same as the skin incision and craniotomy used by us.…”

“…Recent anatomical studies have compared the SO and MP routes to each other and to traditional pterional craniotomies. [19][20][21] However, with the exception of the systematic review by Rychen et al, no clinical series have compared these two approaches for brain tumors or assessed surgical field access and the anatomical regions that benefit from endoscopic visualization. 15 Herein, we report our experience using both approaches to treat over 200 brain tumor patients, with a focus on anatomical access visualized with MRI-based heatmaps, and document clinical outcomes.…”

Extradural minipterional approach for giant intracranial aneurysms

“…Hence, lesions located above the sphenoid ridge and near the midline are more suitable to be approached through shorter and more straightforward routes, such as a supraorbital or an extended supraorbital approach. [ 6 ]…”

“…[ 1 , 11 ] Reports of large aneurysms treated through these small craniotomies are simply scarce. [ 6 , 7 , 9 ] In this manuscript, we present the technical nuances of a variation of the MPT approach, the extradural MPT approach (extMPTa) in the setting of a giant paraclinoid internal carotid artery (ICA) aneurysm.…”

Volumetric 3-Dimensional Analysis of the Supraorbital vs Pterional Approach to Paramedian Vascular Structures: Comprehensive Assessment of Surgical Maneuverability

“…There have been efforts made to quantify both approaches. 13,14 These publications have detailed surgical freedom as a 2D construct that is visually and methodologically interchangeable with the "area of exposure" metric. Studies have attempted to complete a 3D volumetric analysis.…”