Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients

Authors

  • Sabino Luzzi Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
  • Alice Giotta Lucifero Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
  • Matías Baldoncini Department of Neurological Surgery, Hospital San Fernando, Buenos Aires, Argentina
  • Alvaro Campero Department of Neurosurgery, Hospital Padilla, San Miguel de Tucumán, Tucumán, Argentina
  • Samer K. Elbabaa Department of Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
  • Renato Galzio Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy

DOI:

https://doi.org/10.31157/an.v27i4.335

Keywords:

Aneurysms clipping, Intracranial aneurysms, Neurovascular surgery, Pterional approach, Sylvian fissure

Abstract

INTRODUCTION

Most of the versatility of the pterional approach depends on a series of variations progressively reported by several groups, but little emphasized over the years.

The present study condenses the technical notes which the authors adopted in their practice to maximize the surgical freedom of the pterional approach, at once lessening the approach-related complication rate.

METHODS

Data of a series of patients who underwent a pterional approach between January 2011 and May 2021 were retrospectively reviewed focusing on the technical variations compared to the original Yaşargil’s description. The anatomical rationale, technique, and advantages were outlined and validated through the appraisal of functional and cosmetic complications.   

RESULTS

994 patients were reviewed. Head extension was avoided in the case of anterior clinoidectomy. A single double-layered galea-pericranium flap was used for duraplasty. The submuscular technique, with compulsive preservation of deep temporal fascia and deep temporal arteries, was preferred for temporalis muscle dissection. McCarty keyhole was never used, thus avoiding exposing the orbit if unnecessary. Widening of the superior orbital fissure and thinning of the orbital roof allowed to significantly increase the working area. The average follow-up was 7.2 years. The overall rate of functional and cosmetic complications was 2.1.

DISCUSSION

In the authors' experience, the gradual adoption of technical variations related to the patient's positioning, soft tissue dissection, bony work, dura opening, and reconstruction allowed to enhance the versatility of the pterional approach concurrently decreasing the risk of functional and cosmetic complications.

Additional Files

Published

2022-05-26

How to Cite

Luzzi, S., Giotta Lucifero, A. ., Baldoncini, M., Campero, A., Elbabaa, S. K. ., & Galzio, R. (2022). Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients . Archivos De Neurociencias, 27(4). https://doi.org/10.31157/an.v27i4.335

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Section

Original Articles

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