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Osteoplastic Pterional Craniotomy Revisited

Kim, Ealmaan MD, PhD*; Delashaw, Johnny B Jr MD†

doi: 10.1227/NEU.0b013e318207b3e3
Operative Technique

BACKGROUND: A standard pterional approach with a free bone flap to treat brain aneurysms was first introduced and popularized by Yaşargil.

OBJECTIVE: To describe a modified pterional craniotomy technique and that mobilizes part of the sphenoid wing and the pterion in a block with the temporalis muscle to enhance cosmetic results.

METHODS: A subperiosteal corridor is provided inferiorly by separating the temporalis muscle from the underlying bone in a retrograde dissection. Inferior chisel cuts from the front and back enter the sphenoid wing, enabling removal of part of the sphenoid wing and the pterion in 1 piece, along with the bone flap. Forty patients with aneurysms were treated in this fashion, and the cosmetic outcome was examined at 6 months postoperatively.

RESULTS: Thirty-seven patients (92.5%) demonstrated an unremarkable degree of temporalis muscle atrophy. Excellent configuration and fusion of the pterional bone flap were observed on 3-dimensional computed tomography scans.

CONCLUSION: With the use of this muscle-preserving and bone-sparing pterional approach and with little additional labor, temporalis muscle function is preserved and improved cosmesis is obtained.

Author Information

*Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; †Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon

Received, July 28, 2009.

Accepted, September 10, 2010.

Correspondence: Johnny B. Delashaw, Jr, MD, Department of Neurological Surgery, Mail Code CH8N, Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR 97239. E-mail:

Copyright © by the Congress of Neurological Surgeons