title: An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies.
abstract: OBJECTIVE
  To compare anatomically the surgical exposure provided by pterional (PT), orbitozygomatic (OZ), and minisupraorbital (SO) craniotomies.
  
  
  METHODS
  Seven sides of six fixed cadaver heads injected with silicone were used. The mini-SO craniotomy followed by the PT and OZ approaches were performed sequentially. The bony flaps were attached with miniplates and screws, allowing easy conversion between the approaches. A frameless stereotactic device was used to calculate an area of surgical exposure and the angles of approach for six different anatomic targets. An image guidance system was used to demonstrate the limits of the surgical exposure for each technique.
  
  
  RESULTS
  No significant differences were observed in the total area of surgical exposure when comparing the mini-SO (A = 1831.2 +/- 415.3 mm), PT (A = 1860.0 +/- 617.2 mm), and OZ approaches (A = 1843.3 +/- 358.1 mm; P > 0.05). Angular exposure was greater for the OZ and PT approaches than for the mini-SO approach, either in the vertical and horizontal axes, considering all of the six targets studied (P < 0.05). Except for the distal segment of the ipsilateral sylvian fissure, no practical differences in the limits of the exposure were detected.
  
  
  CONCLUSIONS
  The mini-SO approach may offer a similar surgical working area compared with that provided by standard craniotomies and constitutes an excellent alternative to the OZ and PT craniotomies in selected patients. Selection should not be based primarily on the area to be exposed, but rather on the working angles that are anticipated to be required. The key point is to use the most adequate technique for a particular patient, rather than using a one-size-fits-all approach for all patients.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Eberval G
authors.initials: EG
authors.lastname: Figueiredo
authors.forename: Vivek
authors.initials: V
authors.lastname: Deshmukh
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Pushpa
authors.initials: P
authors.lastname: Deshmukh
authors.forename: Marcelo U
authors.initials: MU
authors.lastname: Crusius
authors.forename: Neil
authors.initials: N
authors.lastname: Crawford
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.forename: Mark C
authors.initials: MC
authors.lastname: Preul
mesh_terms: D002102:Cadaver; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D008866:Microsurgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000033:anatomy & histology* / Q000601:surgery*; D015050:Zygoma / Q000033:anatomy & histology* / Q000601:surgery*