Drilling of the marginal tubercle to enhance exposure via mini pterional approach: An anatomical study and clinical series of 25 sphenoid wing meningiomas.

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 the distance, wherein point is the most prominent part of MT and point is located on the orbital rim in the same axial plane as point . 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 the distance measured 13 mm or greater. In the clinical series of SWMs, drilling such prominent MT maximized exposure during MPT approach.

CONCLUSION

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.