Minipterional Craniotomy: An Alternative Approach for Sphenoid Wing Meningiomas

Abstract

Objective: Minipterional craniotomy is a modification of the standard pterional (frontotemporal) craniotomy. It provides the same microsurgical exposure as the standard frontotemporal approach. Material and Methods: We analyzed the relation between the sphenozygomatic suture and the marginal tubercle of the frontal process of the zygoma 60 dried skulls. Minipterional craniotomy was performed in 10 cadaveric specimens. The approach was utilized to 12 sphenoid wing meningiomas. Results: The marginal tubercle was hiding the sphenozygomatic suture when it is > 8 mm, it required drilling to enhance the exposure. Anterior to posterior subperiosteal dissection and retraction of the temporalis muscle, and avoiding cuts along the origin of the muscle allows excellent cosmetic outcome. All 16 meningiomas were successfully resected without morbidity or mortality through a 3.5 to 4 cm bone flap. Conclusions: Minipterional approach is an excellent option to approach sphenoid wing meningiomas. The minimally invasive access allows minimal soft tissue trauma, smaller bony opening, less pain, and excellent cosmetic outcome.