Comparative anatomical analysis between lateral supraorbital and minipterional approaches

Area of Science:

• Neurosurgery
• Vascular Neurosurgery
• Surgical Anatomy

Background:

• The pterional craniotomy is a traditional neurosurgical approach.
• Minimally invasive alternatives like minipterional (MP) and lateral supraorbital (LSO) craniotomies aim to reduce complications.
• These alternatives seek to avoid facial nerve injury, temporal muscle dysfunction, and cosmetic issues.

Purpose of the Study:

• To quantitatively compare the surgical exposures provided by MP and LSO craniotomies.
• To evaluate angular and linear exposures of key neurovascular structures around the circle of Willis and parasellar regions.
• To provide data for selecting between MP and LSO techniques in vascular neurosurgery.

Main Methods:

• Dissection of seven fresh cadavers in São Paulo and three in New York.
• Sequential performance of LSO followed by MP craniotomies.
• Quantitative measurement of surgical exposure area, craniotomy area, and angular exposures in horizontal and vertical axes.

Main Results:

• MP craniotomy provided better angular exposure for the ipsilateral middle cerebral artery (MCA).
• LSO craniotomy demonstrated better vertical axis exposures for the basilar artery (BA) and anterior communicating artery.
• No statistically significant differences were found in overall surgical exposure or craniotomy area between MP and LSO.

Conclusions:

• MP craniotomy offers a significantly larger surgical exposure than LSO craniotomy.
• MP craniotomy has specific advantages for angular exposure to critical neurovascular structures.
• Quantitative data supports informed decision-making for minimally invasive vascular neurosurgery approaches.