Osteoplastic pterional craniotomy revisited.

[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.