title: Modified pterional craniotomy without "MacCarty keyhole".
abstract: Pterional craniotomy is one of the most widely used approaches in neurosurgery. The MacCarty keyhole has remained the preferred means of beginning the craniotomy to achieve a low access point; however, the bone opening may result in a residual defect and an aesthetically unpleasant depression in the periorbital area. We present our modification of the traditional technique. Instead of drilling the keyhole in the frontoperiorbital area, the classical location, we perform a 5 × 15 mm strip craniectomy at the lowest accessible point in the infratemporal fossa, corresponding to the projection of the most lateral point of the sphenoid ridge. The anterior half of this opening exposes the basal frontal dura, while the posterior half brings the temporal dura into view. This modified technique was applied in 48 pterional craniotomies performed for removal of a variety of neoplasms during 2014-2015. There were no approach-related complications. Aesthetic outcomes and patient acceptance have been good; no patient developed skin depression in the periorbital area. In our experience, craniotomy for a pterional approach with the lowest possible access to the frontotemporal skull base may be performed by drilling a narrow oblong opening, without the use of any keyhole or burr hole, to create a smaller skull defect and achieve optimal aesthetic outcomes.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
authors.forename: Samuel
authors.initials: S
authors.lastname: Moscovici
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
authors.forename: Cezar José
authors.initials: CJ
authors.lastname: Mizrahi
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
authors.forename: Emil
authors.initials: E
authors.lastname: Margolin
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address: spektor@hadassah.org.il.
authors.forename: Sergey
authors.initials: S
authors.lastname: Spektor
mesh_terms: D003399:Craniotomy / Q000379:methods*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery
keywords: MacCarty keyhole; Pterional craniotomy; Surgical technique