A pterional flap provides access to the tumor along the sphenoid wing. This may be useful when there is a significant retrochiasmal component, especially where a prefixed chiasm limits the access from the subfrontal direction. The Sylvian fissure is split at its medial aspect to improve access. Unfortunately, despite these maneuvers, access to the pituitary tumor is still limited by the carotid artery and its branches.
Van Alphen termed this the frontotemporal approach and cited the protection of the olfactory tract as a reason for employing it (20). Snow and Patterson have suggested that when pterional access is required, the subfrontal operation may be extended to provide this. A large flap is fashioned to allow access to the subfrontal corridor and also to include the pterion, which is then removed with the highspeed drill (28).
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