Drilling of the marginal tubercle to enhance exposure via mini pterional approach: An anatomical study and clinical series of 25 sphenoid wing meningiomas

BACKGROUND: The marginal tubercle (MT) of zygomatic bone can be an obstacle in the standard mini pterional (MPT) craniotomy; we aim to evaluate the effect of drilling this MT in enhancing the exposure of MPT craniotomy for resection of sphenoid wing meningiomas (SWMs). METHODS: The authors utilized 60 dry skulls to perform the anatomical part of the study. The MT size was reflected by the AB distance, wherein point A is the most prominent part of MT and point B is located on the orbital rim in the same axial plane as point A. The authors analyzed the effect of MT size in masking the sphenozygomatic suture (SZS), which is the most anterior part of the MPT craniotomy. One silicon-injected embalmed specimen was used to demonstrate other modifications to the standard MPT approach. The results of the anatomical analysis were translated into the second part of the study, which consisted of the resection of 25 SWMs. RESULTS: The MT obscured visualization when the AB distance measured 13 mm or greater. In the clinical series of SWMs, drilling such prominent MT maximized exposure during MPT approach. CONCLUSION: The MPT approach could be used for the resection of SWMs. Drilling of prominent MTs can enhance and optimize exposure to SWMs through standard MPT approaches.