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Related Concept Videos

Cranial Bones: Lateral View01:27

Cranial Bones: Lateral View

The lateral view of the cranium is dominated by temporal, sphenoid, and ethmoid bones.
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...
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Updated: Jun 17, 2026

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
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The Lateral Supraorbital Approach: 2-Dimensional Operative Video.

Hugo Andrade-Barazarte1,2, Juha Hernesniemi2

  • 1Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada.

Operative Neurosurgery (Hagerstown, Md.)
|December 29, 2023
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Summary
This summary is machine-generated.

The lateral supraorbital approach (LSO) is a minimally invasive technique for brain aneurysms and tumors. Careful surgical planning and execution are key to avoiding complications and ensuring optimal exposure.

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Area of Science:

  • Neurosurgery
  • Minimally Invasive Surgery
  • Skull Base Surgery

Background:

  • The pterional approach is a traditional method for accessing anterior circulation aneurysms and sellar/suprasellar tumors.
  • Minimally invasive techniques offer potential advantages in reducing surgical morbidity.
  • The lateral supraorbital approach (LSO) has emerged as an alternative for specific neurosurgical pathologies.

Purpose of the Study:

  • To describe the technical nuances and applications of the lateral supraorbital approach (LSO).
  • To highlight the essential steps, anatomical considerations, and potential pitfalls of the LSO.
  • To discuss variations and limitations of the LSO in skull base neurosurgery.

Main Methods:

  • The LSO involves a skin incision behind the hairline and a small craniotomy.
  • A one-layer myocutaneous flap is retracted anteriorly, exposing the superior temporal line and zygomatic process.
  • The craniotomy's inferior limit aligns with the Sylvian fissure, providing access to the anterolateral skull base.

Main Results:

  • The LSO is suitable for anterior circulation aneurysms (excluding distal ACA), some posterior circulation aneurysms, and sellar/suprasellar tumors.
  • Key anatomical landmarks include the superior temporal line and zygomatic process.
  • Potential complications include frontal sinus opening, orbital entry, and inadequate exposure, which can be mitigated by careful planning and neuronavigation.

Conclusions:

  • The lateral supraorbital approach is a valuable minimally invasive technique for select neurosurgical cases.
  • Familiarity with anatomical landmarks and meticulous surgical technique are crucial for successful LSO procedures.
  • Variations and extended techniques allow for broader application of the LSO in complex skull base pathologies.