Morphological and Morphometric Analysis of the Pterion and Its Neurosurgical Implications

Background The pterion is an important craniometrical landmark located on the lateral aspect of the skull, formed by the articulation of the frontal, parietal, squamous temporal, and greater wing of the sphenoid bones. Owing to its close relationship with vital neurovascular structures, such as the anterior division of the middle meningeal artery and the Sylvian fissure, precise knowledge of its morphology and location is essential for neurosurgical interventions, anthropological assessment, and forensic evaluation. This study aimed to investigate the morphological types of pterion and to determine its morphometric relationship with selected bony landmarks in human skulls. Methodology This cross-sectional study was conducted on 100 adult human dry skulls (200 sides) of unknown age and sex, obtained from the Departments of Anatomy at King George's Medical University, Lucknow, and Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India, from December 2022 to November 2023. Pterion was classified into four types based on the sutural pattern. The center of the pterion was identified, and linear distances were measured from this point to the superior border of the zygomatic arch (P-ZA) and the posterolateral margin of the frontozygomatic suture (P-FZS) using a digital vernier caliper with a precision of 0.01 mm. Observations were recorded bilaterally and subjected to statistical analysis using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results Of the 200 pterions examined, the sphenoparietal type was the most common, observed in 160 (80%) sides, followed by the stellate type in 21 (10.5%) sides, the epipteric type in 11 (5.5%) sides, and the frontotemporal type in eight (4%) sides. On the right side, the sphenoparietal pterion was present in 76 (38%) sides, while on the left side, it was seen in 84 (42%) sides. The mean distance from the centre of pterion to the frontozygomatic suture (P-FZS) was 32.82 ± 4.66 mm on the right side and 32.16 ± 4.40 mm on the left side. The mean distance from the centre of pterion to the superior border of the zygomatic arch (P-ZA) was 37.51 ± 4.16 mm on the right side and 36.50 ± 4.13 mm on the left side. Conclusions The present study highlights considerable morphological and morphometric variability of the pterion. A thorough understanding of these variations is crucial for neurosurgeons to accurately localize burr holes and minimize surgical complications. The findings also contribute valuable reference data for anthropologists and forensic experts.