The Pterional Keyhole Craniotomy Approach: A Historical Perspective

Vera Ong; Nolan J Brown; Zach Pennington; Ashley Choi; Shane Shahrestani; Ronald Sahyouni; Mickey E Abraham; Joshua J Loya

doi:10.1016/j.wneu.2023.07.012

The Pterional Keyhole Craniotomy Approach: A Historical Perspective

World Neurosurg. 2023 Nov:179:77-81. doi: 10.1016/j.wneu.2023.07.012. Epub 2023 Jul 8.

Authors

Vera Ong¹, Nolan J Brown², Zach Pennington³, Ashley Choi⁴, Shane Shahrestani⁵, Ronald Sahyouni⁶, Mickey E Abraham⁶, Joshua J Loya⁷

Affiliations

¹ John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA.
² Department of Neurological Surgery, University of California, Irvine, Orange, California, USA.
³ Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁴ California University of Science and Medicine, Colton, California, USA.
⁵ Medical Scientist Training Program, California Institute of Technology, Pasadena, California, USA; Keck School of Medicine of USC, Los Angeles, California, USA.
⁶ Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA.
⁷ Department of Neurological Surgery, Oregon Health and Sciences University, Portland, Oregon, USA. Electronic address: loyaj@ohsu.edu.

PMID: 37429377
DOI: 10.1016/j.wneu.2023.07.012

Abstract

The pterional craniotomy is a workhorse of cranial surgery that provides access to the anterior and middle fossae. However, newer "keyhole" approaches, such as the micropterional or pterional keyhole craniotomy (PKC) can offer similar exposure for many pathologies while reducing surgical morbidity. The PKC is associated with shorter hospitalizations, reduced operative time, and superior cosmetic outcomes. Furthermore, it represents an ongoing trend toward smaller craniotomy size for elective cranial procedures. In this historical vignette, we trace the history of the PKC from its origins to its current role in the neurosurgeon's armamentarium.

Keywords: Aneurysm; Craniotomy; Keyhole; Micropterional.

Publication types

Review

MeSH terms

Craniotomy / methods
Humans
Intracranial Aneurysm* / surgery
Minimally Invasive Surgical Procedures / methods
Neurosurgical Procedures* / methods
Treatment Outcome