Functional and Cosmetic Outcomes of Pterional Craniotomy and Its Modifications: A Scoping Review

Pterional craniotomy is a widely used approach for anterior and middle fossa pathologies; however, violation of the temporalis muscle may result in cosmetic deformities and functional deficits, including temporal hollowing and frontalis weakness. Over the past decade, multiple surgical modifications have been proposed to minimize these complications. However, no consensus has been reached regarding the optimal technique. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided review of recent literature evaluating temporalis-preserving or reconstructive approaches in pterional craniotomy. Across 18 studies involving 1,339 patients, both the mini-pterional and osteoplastic techniques were associated with superior cosmetic and functional outcomes compared with the traditional pterional approach, with notable advantages for specific aneurysm locations. These findings highlight the growing emphasis on quality of life after craniotomy and suggest that tailored technique selection may improve patient-centered outcomes.