The One-Piece Orbitopterional Approach

The orbitopterional approach is an anterior skull base extension of the pterional approach that provides greater exposure to the anterior cranial fossa, supra- and parasellar regions, and anterior communicating artery complex. We describe the surgical technique in a stepwise manner to create a one-piece orbitopterional craniotomy flap; keyholes for the bone cuts are the MacCarty burr-hole and the anterolateral portion of the inferior orbital fissure. This one-piece technique is less complicated than the two-piece orbitopterional craniotomy and eliminates the need for complex reconstruction of cosmetically important areas (i.e., the orbit and forehead).