Pterional Approach: Operative Technique and Surgical Applications

Abstract

the pterional approach (PA), is one of the most widely used approaches in cranial surgery. This is because, through the sylvian fi ssure (SF), it allows access to the subarachnoid cisterns, the insula, and the mesial temporal lobe. Even nowadays, the PA it is still a published topic, although it was fi rst described more than 40 years ago by Yaş argil. Over time, multiple variants were added to the PA, including minipterional, transzygomatic, and orbitozygomatic approaches. The PA takes the pterion as the midpoint, thus exposing a small section of the lateral part of the frontal, parietal, temporal (squamous), and sphenoid (greater wing) bones. In this way, the PA makes it possible to expose, through the SF and the lateral subfrontal via, the insula, the basal ganglia, the mesial temporal region, the supra and parasellar area, a large part of the anterior and middle fossa, and the basal cisterns. The PA is based on exposure and opening of the SF. Therefore, accurate anatomic knowledge of the SF is necessary, as well as the techniques to open it; when separating both opercula, upper or frontal and lower or temporal, the neurosurgeon is able to approach multiple anatomic structures that were previously described.