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Instituto Nacional de Neurología y Neurocirugía

2022, Number 4

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Arch Neurocien 2022; 27 (4)

Pterional approach: technical variations, functional, and cosmetic outcomes in a series of 1000 patients

Luzzi S, Giotta LA, Baldoncini M, Campero A, Elbabaa SK, Galzio R

Language: English
References: 58
Page: 5-16
PDF size: 837.49 Kb.


ABSTRACT

Introduction: Most of the versatility of the pterional approach is based on a series of variations progressively reported by several authors, 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 and to lessen 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 description by Yasargil. The anatomical rationale, technique, and advantages of these variations 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 clinical follow-up was 7.2 years. The overall rate of functional and cosmetic complications was 2.1.
Discussion: According to the authors’ experience, the gradual adoption of technical variations related to the positioning of the patient, 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.


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