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Updated: Aug 14, 2025
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Subfascial dissection and extended temporal muscle detachment for middle fossa approach
Guilherme Finger1, Vivian F Kaul2, Oliver F Adunka2
1Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10Th Ave, Columbus, OH, 43210, USA. guilhermefingermd@gmail.com.
Background:
The soft tissue dissection for the middle fossa approach requires adequate management of the neuro, vascular, and muscular structures in order to maximize exposure and diminish morbidities.
Methods:
An incision anterior to the tragus is performed, extending from the zygomatic process to the superior temporal line. The superior temporal artery is exposed, followed by a subfascial dissection of the frontalis nerve. The temporal muscle is dissected and released from the zygoma. All cranial landmarks are exposed for the 5 × 5 cm temporal fossa craniotomy.
Conclusion:
This novel approach provides a safe and adequate access to perform an extended middle fossa craniotomy.
