Extended Lateral Orbital Craniotomy: Anatomic Study and Initial Clinical Series of a Novel Minimally Invasive Pterional Approach

Mithun G. Sattur, Karl R. Abi-Aad, Matthew E. Welz, Rami James Aoun, Chandan Krishna, Chad Purnell, Mohammed Alghoul, Bernard R. Bendok

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background âof the minimally invasive keyhole alternatives to the pterional region, the supraorbital eyebrow approach is the most widely adopted. Yet it can prove disadvantageous when a more direct lateral microsurgical trajectory of attack to the Sylvian fissure and anterior middle fossa are needed. Objective âhe extended lateral orbital (XLO) approach was designed to be direct and minimally invasive, with the sphenoid ridge at the center of exposure. Methods âive injected cadaver heads were used for anatomic study of the XLO approach. The anatomic course of the frontalis branch of facial nerve was studied in relation to the XLO incision. Following XLO incision, the bone exposure was measured. The intracranial microsurgical exposure was assessed subjectively. Application of the technique in representative clinical operative cases is provided. Results âhe frontalis nerve was protected in the subgaleal fat pad, with an average minimum distance of 2.3 cm from the XLO incision. The mean calvarial area exposure was 4.95 cm 2 and consistently centered on the sphenoid ridge. Excellent access to ipsilateral Sylvian's fissure, perisylvian regions, and supra-/parasellar structures was possible. The main limitations related to exposure of the posterior Sylvian fissure and the expected limitations of microsurgical instrument manipulation from a smaller craniotomy. Conclusions âhe XLO approach is a minimally invasive keyhole approach to the pterional region that affords a unique lateral trajectory via a craniotomy centered on the sphenoid ridge. Excellent exposure to properly selected lesions is possible. The incision is at a safe distance from the frontalis branch and shows excellent cosmetic healing.

Original languageEnglish (US)
Pages (from-to)88-96
Number of pages9
JournalJournal of Neurological Surgery, Part B: Skull Base
Issue number1
StatePublished - 2020


  • Sylvian fissure
  • frontalis branch of facial nerve
  • micro surgical clipping
  • middle cerebral artery aneurysm
  • minimally invasive craniotomy
  • pterional keyhole approach
  • sphenoid ridge

ASJC Scopus subject areas

  • Clinical Neurology


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