Abstract
The pterional approach is commonly employed in surgery of the anterior circulation
and upper basilar artery aneurysms, as well as for the tumors of orbital, retroorbital,
sellar, chiasmatic, subfrontal and prepontine areas and lesions around the sella especially
for lesions behind the clivus. Also tumors arising from the medial sphenoid ridge,
the superior orbital fissure, the anteromedial temporal surface, or the cavernous
sinus region are approached through a pterional exposure.
The surgical technique is based on the experience, training and observation of the
neurosurgeon. One technique is not necessarily better than another. Regardless of
the surgical technique, the end results depend on a rigorous, methodical, systematic,
and step-by-step approach to the target, securing it with minimal injury to surrounding
structures.
In this study, we have analyzed the intraoperative anatomical findings of the Sylvian
vein and fissure, lenticulostriatal artery, olfactory nerve, and recurrent artery
of Heubner and showed the surgical pitfalls in 700 patients with different diagnoses that were
operated on with the pterional approach. The findings were recorded during surgical
interventions and through the slides and videotapes of the operations. Also, we have
stressed the preservation of the frontotemporal branch of the facial nerve, the delicate
retraction of frontal lobe, the cottonoid retraction in temporal lobe and the preservation
of olfactory nerve functions.
Key words
Frontal branch of facial nerve - Sylvian dissection - Brain retraction - Olfactory
nerve - Dural artery -
Heubner's artery
