Supraorbital Keyhole Versus Pterional Approach: A Morphometric Anatomical Study.

Area of Science:

• Neurosurgery
• Minimally Invasive Techniques
• Surgical Anatomy

Background:

• The supraorbital (SO) keyhole approach is increasingly recognized for its potential in accessing cranial base regions.
• Its routine clinical utility, especially with advancements in surgical technology, requires thorough evaluation against established techniques like Pterional (PT) craniotomy.

Purpose of the Study:

• To conduct a cadaveric morphometric analysis comparing the supraorbital (SO) keyhole approach with the standard Pterional (PT) craniotomy.
• To evaluate the anatomical exposure and surgical field provided by the SO keyhole approach for supra- and parasellar regions.

Main Methods:

• A cadaveric study utilizing 8 ETOH-fixed and silicone-injected human heads for each surgical approach (SO and PT).
• Pre- and post-dissection CT scans and pre-dissection MRI were employed for neuro-navigation and verification of anatomical landmarks.
• Morphometric analysis was performed to quantify the differences in exposure.

Main Results:

• Despite a smaller craniotomy size, the SO approach demonstrated superior anatomical exposure compared to the PT approach.
• A 30° head rotation significantly enhanced the surgical field of the suprasellar region when using the SO keyhole.

Conclusions:

• The SO keyhole approach is a suitable alternative for accessing the supra- and parasellar regions.
• Detailed preoperative image-guided surgical planning is crucial for optimizing the effectiveness of the SO keyhole approach.