Pterional craniotomy is a versatile and frequently used approach in neurosurgery[^1].

History

The earliest descriptions of pterional craniotomy for the evacuation of Epidural hematomas date back to the 1850s[^2].

Uses

Pterional craniotomy can be used for lesions located subfrontally, temporally, parasellarly, or tentorially. Lesions located above the Foramen of Monro generally cannot be reached via a pterional craniotomy.

Positioning and skin incision

Depending on the lesion, the head is rotated 30-60° from the supine position and slightly extended, with the Zygoma positioned as the highest point. The more anteriorly located the surgical target, the greater the degree of rotation away from the supine position. If possible, the head should be slightly elevated to improve venous drainage and minimize intraoperative bleeding. The skin incision begins at the Tragus, initially extending straight toward the Vertex, and then continuing in a concave curve toward the midline behind the hairline.

Landmarks for the craniotomy

Medially, the craniotomy should extend no farther than the Midpupillary line. Anteriorly, the Frontotemporal region and, caudally, the zygoma should be readily palpable with the finger.