Lateral Supraorbital Approach vs Pterional Approach: An Anatomic Qualitative and Quantitative Evaluation

Abstract

From an anatomic point of view, both approaches provide similar exposure to the sellar, suprasellar, and anterior communicating artery areas. The pterional approach provides better exposure of the retrosellar area. The ability to operate in the retrosellar area, as judged by our model, was higher with the pterional than with the lateral supraorbital approach.

Comparison between Lateral Supraorbital Approach and Pterional Approach in the Surgical Treatment of Unruptured Intracranial Aneurysms

“…The lateral supraorbital approach provides a longer route to the basilar tip and a lesser exposure volume, and consequently needs more frontal lobe retraction before reaching the chiasmatic and carotid cisterns7). However, in the lateral supraorbital approach, the temporal muscle splitting is limited to its superior and anterior part, because the small skin incision never descends in front of the ear to the level of the zygomatic arch; thus, any injury of the upper branches of the facial nerve can be avoided by detaching the one layer skin-galea-muscle flap from the bone.…”

A 16 Year Experience with Modified Lateral Supraorbital Approach for Ruptured Cerebral Aneurysms

“…However, it has the limitation on the sylvian dissection at the level of the limen insulae, so more brain retractions are needed to approach the proximal ICA or basilar artery area [9]. Consequentially, the two approaches have similar surgical exposure in the sellar, suprasellar and the anterior communicating artery space, but the standard pterional approach is considered more appropriate for approaching the retrosellar area.…”

Microscopic and endoscopic anterior communicating artery complex anatomy as seen through keyhole approaches

“…1), the degree of visualization and the quality of the surgical access. We used the Surgical Exposure Grading System described by Salma et al 9 to evaluate each approach ( …”

“…Acomm 3 3 3 3 3 3 A 1 5 5 5 5 3 4 A 2 2 3 3 4 3 5 R A H 2 3 3 4 3 4 I C A 4 4 3 4 3 4 A1 and A2 = the fist and second segments of the anterior cerebral artery, Acomm = anterior communicating artery complex, ICA = internal carotid arteries (ICA), RAH = recurrent arteries of Heubner. Exposure grades have been modified from Salma et al 9 See Table 1.…”