Three-step anterolateral approaches to the skull base

Area of Science:

• Neurosurgery
• Surgical Anatomy

Background:

• Adequate intraoperative brain exposure is crucial to prevent parenchymal injury.
• Skull base lesions often require complex surgical access.
• Existing anterolateral approaches are typically discussed independently.

Purpose of the Study:

• To present a unified, multi-step anterolateral surgical approach for brain exposure.
• To demonstrate the spectrum of pterional, orbitozygomatic, and transzygomatic approaches.
• To provide a modified craniotomy technique for optimal surgical exposure.

Main Methods:

• Description of a three-step anterolateral surgical technique using ten hemispheres.
• Integration of pterional, orbitozygomatic, and transzygomatic approaches.
• Detailed anatomical considerations for each step of the approach.

Main Results:

• The combined approach provides comprehensive access to the anterior skull base, middle fossa, and upper posterior fossa.
• Specific steps allow tailored exposure for lesions including the Sylvian fissure, circle of Willis, optic nerves, and hypothalamic regions.
• Modification of the zygomatic arch and lateral orbital wall enhances vertical access.

Conclusions:

• The described three-step anterolateral approach offers a spectrum of exposure options for diverse skull base pathologies.
• This unified perspective simplifies understanding and application of these techniques.
• The approach facilitates modified craniotomies for improved surgical access and reduced brain retraction.