Management of complex brain lesions arising at sellar, petroclival, and interpeduncular regions via the pretemporal approach: Technical note

Abstract

Background: Lesions of sellar, interpeduncular, and petroclival regions represent surgical challenges due to the spatial limitations imposed by the temporal lobe. The pretemporal approach is rarely advocated for this kind of lesions even when it offers a wider operative field than other traditional techniques. Case presentation: Here, we share our experience with the use of the pretemporal approach in a small case series: a giant meningioma of the tentorial notch (case 1), an aneurysm of the left posterior cerebral artery (case 2), and a giant pituitary adenoma (case 3). A frontotemporal incision was made with patients in supine position, their heads turned to the opposite side, and the malar eminence as their upper point. The skin flap and the temporal muscle were retracted anteriorly and inferiorly, respectively. The frontotemporosphenoidal craniotomy was performed and the lesser sphenoid wing removed. For cases 2 and 3, an orbitozygomatic craniotomy was added. After an S-shaped dura matter opening, the access to the interpeduncular fossa was through the sylvian fissure by careful dissection of adhesions between frontal and temporal lobes. Conclusions: On experienced hands, the pretemporal approach is a safe procedure for the management of lesions located in deep brain areas with low postoperative morbidity.

Keywords

• Pretemporal approach
• Meningioma
• Cerebral aneurysms
• Neurosurgery