The Pterional Keyhole Craniotomy: A Historical Perspective on Its Development and Role within Skull Base Neurosurgery

Introduction: The traditional pterional craniotomy provides access to the anterior and middle fossa, however it has been associated with poor cosmesis, facial nerve injury, and extensive skin retraction. The micropterional or pterional keyhole craniotomy (PKC) provides the same advantages as the traditional pterional craniotomy while reducing overall surgical exposure. It has been observed to decrease overall length of hospital stay, operative time, as well as improve cosmetic outcomes following surgery for lesions adjacent to the pterion. Overall, it demonstrates a promising trajectory within microsurgical skull base neurosurgery. In the present study, we trace the history of the PKC from its origins to its current role in the neurosurgeon's armamentarium.