16 Mini-Pterional Approach The mini-pterional approach is a lateral approach, which enables access to the trans-sylvian corridor through a minimally invasive craniotomy. The approach is indicated for vascular pathology involving the anterior circulation, for extra-axial lesions of the anterior skull base and parasellar area, as well as intra-axial lesions of the inferior aspect of the frontal lobe. • Anterior circulation aneurysms • Anterior skull base meningiomas • Parasellar tumors (e.g., craniopharyngiomas) • Less common: Inferior frontal and fronto-orbital pathology • Position: The patient is positioned supine with torso flexed slightly downward. • Head: The head is extended 20°, rotated 5°to contralateral side for most pathologies. • The ipsilateral malar eminence is the highest point in the surgical field. • The single pin should be placed on the ipsilateral side superior to the mastoid process. On the two-pin arm, one pin is placed superior to the mastoid process on the contralateral side and the other superiorly over the parietal bone. • Small, lightly curved incision ◦ Starting point: Incision starts just inside the sideburn, 2 fingerbreadths anterior to the pinna. ◦ Course: Incision runs along the hairline in a downward arc. ◦ Ending point: It curves anteriorly making a cut no longer than 6-7 cm. • Superficial temporal artery. • Frontal branch of the facial nerve. • Myofascial and muscular layers ◦ The scalp is reflected antero-inferiorly and postero-superiorly to expose the superficial temporoparietal fascia. ◦ Temporal fascia is elevated in a sub-fascial incision and retracted to protect the frontal branch of the facial nerve. ◦ A “T-cut” is made in the upper posterior corner of the temporal muscle, and spread away from the inferior edge. • Bone exposure ◦ Subperiosteal dissection proceeds until the sphenoid wing is exposed.
16.1 Introduction
16.2 Indications
16.3 Patient Positioning (Fig. 16.1)
16.4 Skin Incision (Fig. 16.2)
16.4.1 Critical Structures
16.5 Soft Tissue Dissection (Figs. 16.3, 16.4)
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