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. 2019 Jul 23;11(7):e5216. doi: 10.7759/cureus.5216

Figure 10. Schematic drawings of a right pterional approach with extra-dural removal of the anterior clinoid process .

Figure 10

A) Schematic drawing of the skin incision and craniotomy of the pterional approach. Care should be taken to avoid injuring the anterior branch of the middle meningeal artery and temporal branches of the facial nerve.

B) The blue shaded area shows the part of the optic canal roof that must be removed if an extension of drilling the lesser wing of sphenoid or extra-dural anterior clinoidectomy is necessary. OC, optic canal; SOF, superior orbital fissure.

C) Intraoperative view after the pterional craniotomy. The blue shaded area (part of the optic canal roof) must be removed for further medial exposure. ON, optic nerve; SOF, superior orbital fissure.

D) Intraoperative view after part of the optic canal roof is removed. The meningo-orbital band (MOB) connects the periosteal layer of the frontotemporal basal dura to the periosteal layer of the periorbita and demarks the transition between the medial and lateral portions of the middle fossa. By partially removing part of the optic canal roof and separating the dura propria of temporal lobe from the inner cavernous membrane, the MOB can be safely detached from the periorbita to expose the middle cranial fossa, including the anterior clinoid process. ACP, anterior clinoid process; MOB, meningo-orbital band; ON, optic nerve; SOF, superior orbital fissure.