Osteoplastic Monobloc Pterional Craniotomy: A Technical Note

Objective: This report describes a novel technique for cosmetic pterional craniotomy. In an effort to enhance cosmetic results, the authors essentially turn an osteoplastic bone flap, leaving the temporalis muscle attached to the bone, and make the inferior cuts with osteotomes.

Methods: A subperiosteal corridor is provided inferiorly by separating the temporalis muscle from the underlying bone subperiosteally. The inferior chisel cuts from the front and back enter the sphenoid wing, enabling the authors to remove part of the sphenoid wing and the pterion in one piece along with the bone flap.

Results: Forty patients underwent a successful modified osteoplastic frontotemporal craniotomy and 37 (92.5%) demonstrated an unremarkable degree of temporalis muscle atrophy. Temporalis muscle volume overlying the bone flap was not significantly different between normal and lesion sides.

Conclusion: By utilizing this muscle-preserving and bone-sparing pterional approach, and with little additional labor, temporalis muscle function is preserved and improved cosmesis is obtained.