Perspective of the frontolateral craniotomies

Abstract

The pterional craniotomy is one of the most frequently surgical approaches used in neurosurgery and currently it has become a mainsteam. It allows excellent microsurgical exposure of anterior and posterior regions of the arterial circle of Willis, supra and paraselar regions, the superior orbital fissure of sphenoid bone, cavernous sinus, orbit, temporal lobe, midbrain and the frontal lobe. Like others techniques, the pterional craniotomy presented disadvantages related to dissection of the temporal muscle. From the first fronto lateral craniotomy described by Dandy to expose the optic chiasm and the pituitary we pass through the Yasargil's classical description of craniotomy centered in fronto-temporal sylvian fissure until reaching the recent"minipterional craniotomy", modifications of the pterional craniotomy were proposed to reduce the extra cranial tissue trauma and reduce the area of craniotomy without affecting the exposure of surgical targets, thus improving their aesthetic and functional results. An historical analysis of the frontolateral approaches has demonstrated that they have evolved from larger craniotomies to smaller ones, however only the minipterional craniotomy is able to offer similar surgical exposure.