Lateral supraorbital approach vs pterional approach: an anatomic qualitative and quantitative evaluation

Several minimally invasive modifications of the standard pterional approach have been proposed recently. The lateral supraorbital approach is one of these modifications.

To provide a qualitative and quantitative anatomic comparison of the surgical exposure and the operability afforded by the standard pterional approach and the lateral supraorbital approach.

Eight pterional approaches and 8 lateral supraorbital approaches were used in 8 fresh human cadaver heads. One qualitative and 2 quantitative tools were used to assess the surgical exposure.

Qualitatively, the lateral supraorbital approach has the advantages of reduced trauma to the temporalis muscle and exposure that is comparable to that provided by the standard pterional approach to the sellar and suprasellar regions. This approach offers limited exposure of the interpeduncular fossa compared with the pterional one. Quantitatively, the pterional approach provides a greater surgical volume than the lateral supraorbital approach (32.90 mL vs 23.60 mL with P < .05). Also, the pterional approach provides a greater associated surgical operability than the lateral supraorbital approach (exposure score of 66 and 53, respectively). However, the lateral supraorbital approach offers an equivalent access to the anterior communicating artery complex, optic nerve, optic chiasm, and sellar area (the exposure scores were 19 for both approaches).

From an anatomic point of view, both approaches provide similar exposure to the sellar, suprasellar, and anterior communicating artery areas. The pterional approach provides better exposure of the retrosellar area. The ability to operate in the retrosellar area, as judged by our model, was higher with the pterional than with the lateral supraorbital approach.