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Updated: Apr 1, 2026

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

Published on: August 11, 2015

Modified pterional craniotomy without "MacCarty keyhole".

Samuel Moscovici¹, Cezar José Mizrahi¹, Emil Margolin¹

¹Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia

|October 13, 2015

Summary

This summary is machine-generated.

This study modified the pterional craniotomy technique by using a strip craniectomy instead of a keyhole. This approach reduces skull defects and improves aesthetic outcomes in neurosurgery patients.

Keywords:

MacCarty keyhole Pterional craniotomy Surgical technique

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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

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Area of Science:

Neurosurgery
Surgical Techniques
Skull Base Surgery

Background:

Pterional craniotomy is a common neurosurgical approach.
The traditional MacCarty keyhole can lead to periorbital defects and aesthetic concerns.
Minimizing iatrogenic defects is crucial for patient outcomes.

Purpose of the Study:

To present a modified pterional craniotomy technique.
To evaluate the safety and aesthetic results of the modified approach.
To reduce the incidence of periorbital depression after craniotomy.

Main Methods:

A modified technique involving a 5 × 15 mm strip craniectomy in the infratemporal fossa was developed.
This approach targets the lowest accessible point near the sphenoid ridge.
The technique was applied in 48 pterional craniotomies for tumor removal.

Main Results:

No approach-related complications were observed in the 48 cases.
All patients reported good aesthetic outcomes.
No instances of skin depression in the periorbital area occurred.

Conclusions:

The modified pterional craniotomy offers a safe and effective alternative to the traditional keyhole technique.
This approach minimizes skull defects, leading to superior aesthetic results.
The strip craniectomy provides adequate access to the frontotemporal skull base with improved cosmetic benefits.