The Extended Minipterional Approach: A Modification to Approach the Insular Region

Background: For its versality and wide acceptance, the pterional craniotomy has become the mainstay of treatment for most of the anterior circulation aneurysms, parasellar lesions and tumors located in the anterior cranial fossa. Minipterional approach (MPTa) was introduced as a less invasive alternative to treat anterior and middle fossa lesions and anterior circulation aneurysms. As in other minimally invasive approaches, the MPT offers better cosmetic results, protection of the underlying brain parenchyma, shorter operative times, and less soft tissues injury. Nonetheless, soon after its first description, several authors raised their concerns regarding the reduced surgical freedom of movement and the limited operative view using the MPTa. In fact, one limitation of the MPTa is the reduced exposure of the distal Sylvian fissure, which preclude a wide dissection, limiting the access to lesions located deep at the Sylvian cistern.