title: Drilling of the marginal tubercle to enhance exposure via mini pterional approach: An anatomical study and clinical series of 25 sphenoid wing meningiomas.
abstract: BACKGROUND
  The marginal tubercle (MT) of zygomatic bone can be an obstacle in the standard mini pterional (MPT) craniotomy; we aim to evaluate the effect of drilling this MT in enhancing the exposure of MPT craniotomy for resection of sphenoid wing meningiomas (SWMs).
  
  
  METHODS
  The authors utilized 60 dry skulls to perform the anatomical part of the study. The MT size was reflected by theABdistance, wherein pointAis the most prominent part of MT and pointBis located on the orbital rim in the same axial plane as pointA. The authors analyzed the effect of MT size in masking the sphenozygomatic suture (SZS), which is the most anterior part of the MPT craniotomy. One silicon-injected embalmed specimen was used to demonstrate other modifications to the standard MPT approach. The results of the anatomical analysis were translated into the second part of the study, which consisted of the resection of 25 SWMs.
  
  
  RESULTS
  The MT obscured visualization when theABdistance measured 13 mm or greater. In the clinical series of SWMs, drilling such prominent MT maximized exposure during MPT approach.
  
  
  CONCLUSIONS
  The MPT approach could be used for the resection of SWMs. Drilling of prominent MTs can enhance and optimize exposure to SWMs through standard MPT approaches.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris VII-Diderot, Paris, France.
authors.forename: Nouman
authors.initials: N
authors.lastname: Aldahak
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Tantowy
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Derrick
authors.initials: D
authors.lastname: Dupre
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Keller
authors.affiliation: Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris VII-Diderot, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Froelich
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Aziz
keywords: Anatomic study; meningioma; minimally invasive neurosurgery; minipterional approach; skull base; surgical technique