title: Osteoplastic pterional craniotomy revisited.
abstract: BACKGROUND
  A standard pterional approach with a free bone flap to treat brain aneurysms was first introduced and popularized by Yaşargil.
  
  
  OBJECTIVE
  To describe a modified pterional craniotomy technique and that mobilizes part of the sphenoid wing and the pterion in a block with the temporalis muscle to enhance cosmetic results.
  
  
  METHODS
  A subperiosteal corridor is provided inferiorly by separating the temporalis muscle from the underlying bone in a retrograde dissection. Inferior chisel cuts from the front and back enter the sphenoid wing, enabling removal of part of the sphenoid wing and the pterion in 1 piece, along with the bone flap. Forty patients with aneurysms were treated in this fashion, and the cosmetic outcome was examined at 6 months postoperatively.
  
  
  RESULTS
  Thirty-seven patients (92.5%) demonstrated an unremarkable degree of temporalis muscle atrophy. Excellent configuration and fusion of the pterional bone flap were observed on 3-dimensional computed tomography scans.
  
  
  CONCLUSIONS
  With the use of this muscle-preserving and bone-sparing pterional approach and with little additional labor, temporalis muscle function is preserved and improved cosmesis is obtained.
authors.affiliation: Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
authors.forename: Ealmaan
authors.initials: E
authors.lastname: Kim
authors.forename: Johnny B
authors.initials: JB
authors.lastname: Delashaw
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011446:Prospective Studies; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed