Video 3. 3D (stereoscopic) stop motion video depicting a pterional approach.
The skin incision starts at the superior rim of the zygomatic arch and arcs to the midline. The scalp flap, along with the underlying STA, is retracted anteriorly over the orbit until the superior edge of the suprafascial fat pad is observed. Superior to the STL, the frontal pericranium is exposed; inferiorly, the superficial temporal fascia is exposed. Interfascial dissection is performed along the most anterior part of the STL. Subfascial dissection is also performed to dissect both layers of temporal fascia and expose the temporalis muscle. A musculo-fascial cuff is left along the STL. The temporalis muscle is dissected along the STL and reflected anteroinferiorly over the zygomatic arch. The MacCarty keyhole is identified 5-6 mm posterior to the three-junction suture. The second burr hole is drilled above the zygomatic arch in the temporal bone. The frontotemporal craniotomy is carefully performed around the pterion and the bone flap is removed to expose the dura and anterior branch of the middle meningeal artery. A rongeur and drill are used to flatten the lesser wing of sphenoid and expand the subfrontal space. Abbreviations: STA, superficial temporal artery; STL, superior temporal line.