{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:12Z","timestamp":1786125852806,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Both the pterional and supraorbital approaches have been proposed as optimal access corridors to deep and paramedian anatomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To assess key intracranial structures accessed through the surgical approaches using the angle of attack (AOA) and the volume of surgical freedom (VSF) methodologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Ten pterional and 10 supraorbital craniotomies were completed. Data points were measured using a neuronavigation system. A comparative analysis of the craniocaudal AOA, mediolateral AOA, and VSF of the ipsilateral paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA) complex was completed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      For the paraclinoid ICA, the pterional approach produced larger craniocaudal AOA, mediolateral AOA, and VSF than the supraorbital approach (28.06\u00b0 vs 10.52\u00b0, 33.76\u00b0 vs 23.95\u00b0, and 68.73 vs 22.59 mm\n                      <jats:sup>3<\/jats:sup>\n                      normalized unit [NU], respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). The terminal ICA showed similar superiority of the pterional approach in all quantitative parameters (27.43\u00b0 vs 11.65\u00b0, 30.62\u00b0 vs 25.31\u00b0, and 57.41 vs 17.36 mm\n                      <jats:sup>3<\/jats:sup>\n                      NU;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). For the ACoA, there were statistically significant differences between the results obtained using the pterional and supraorbital approaches (18.45\u00b0 vs 10.11\u00b0, 29.68\u00b0 vs 21.01\u00b0, and 26.81 vs 16.53 mm\n                      <jats:sup>3<\/jats:sup>\n                      NU;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .005).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>The pterional craniotomy was significantly superior in all instrument maneuverability parameters for approaching the ipsilateral paraclinoid ICA, terminal ICA, and ACoA. This global evaluation of 2-dimensional and 3-dimensional surgical freedom and instrument maneuverability by amalgamating the craniocaudal AOA, mediolateral AOA, and VSF produces a comprehensive assessment while generating spatially and anatomically accurate corridor models that provide improved visual depiction for preoperative planning and surgical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1227\/ons.0000000000000044","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T13:27:32Z","timestamp":1640179652000},"page":"66-74","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Volumetric 3-Dimensional Analysis of the Supraorbital vs Pterional Approach to Paramedian Vascular Structures: Comprehensive Assessment of Surgical Maneuverability"],"prefix":"10.1227","volume":"22","author":[{"given":"Lena Mary","family":"Houlihan","sequence":"first","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irakliy","family":"Abramov","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanapong","family":"Loymak","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jubran H.","family":"Jubran","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann J.","family":"Staudinger Knoll","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara S.","family":"Farhadi","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Naughton","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob T.","family":"Howshar","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G. J.","family":"O'Sullivan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Lawton","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Preul","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12,22]]},"reference":[{"issue":"2","key":"R1-20250821","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3171\/jns.1986.64.2.0183","article-title":"Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery","volume":"64","author":"Suzuki","year":"1986","journal-title":"J Neurosurg."},{"key":"R2-20250821","doi-asserted-by":"crossref","first-page":"e552","DOI":"10.1016\/j.wneu.2017.11.051","article-title":"Medical malpractice in neurosurgery: a comprehensive analysis","volume":"110","author":"Thomas","year":"2018","journal-title":"World Neurosurg."},{"issue":"4","key":"R3-20250821","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/00006123-198210000-00016","article-title":"The supraorbital approach: technical note","volume":"11","author":"Jane","year":"1982","journal-title":"Neurosurgery."},{"issue":"2","key":"R4-20250821","first-page":"83","article-title":"Microsurgical pterional approach to aneurysms of the basilar bifurcation","volume":"6","author":"Yasargil","year":"1976","journal-title":"Surg Neurol."},{"issue":"6","key":"R5-20250821","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.3171\/2020.3.JNS193205","article-title":"Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation","volume":"134","author":"Zhao","year":"2020","journal-title":"J Neurosurg."},{"issue":"5","key":"R6-20250821","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1055\/s-0034-1372467","article-title":"Comparison of surgical freedom and area of exposure in three endoscopic transmaxillary approaches to the anterolateral cranial base","volume":"75","author":"Elhadi","year":"2014","journal-title":"J Neurol Surg B Skull Base."},{"issue":"4 suppl 2","key":"R7-20250821","first-page":"ONS212","article-title":"An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies","volume":"59","author":"Figueiredo","year":"2006","journal-title":"Neurosurgery."},{"key":"R8-20250821","doi-asserted-by":"crossref","first-page":"628797","DOI":"10.3389\/fbioe.2021.628797","article-title":"Volume of surgical freedom: the most applicable anatomical measurement for surgical assessment and 3-dimensional modeling","volume":"9","author":"Houlihan","year":"2021","journal-title":"Front Bioeng Biotechnol."},{"issue":"2","key":"R9-20250821","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1093\/ons\/opy309","article-title":"Comparative analysis of the exposure and surgical freedom of the endoscopic extended minipterional craniotomy and the transorbital endoscopic approach to the anterior and middle cranial fossae","volume":"17","author":"Noiphithak","year":"2019","journal-title":"Oper Neurosurg."},{"issue":"4","key":"R10-20250821","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.3171\/2019.4.JNS19351","article-title":"Quantitative analysis of ipsilateral and contralateral supracerebellar infratentorial and occipital transtentorial approaches to the cisternal pulvinar: laboratory anatomical investigation","volume":"133","author":"Sun","year":"2020","journal-title":"J Neurosurg."},{"issue":"5 suppl 2","key":"R11-20250821","first-page":"273","article-title":"Microsurgical management of anterior communicating artery aneurysms","volume":"61","author":"Sekhar","year":"2007","journal-title":"Neurosurgery."},{"issue":"12","key":"R12-20250821","doi-asserted-by":"crossref","first-page":"2513","DOI":"10.1007\/s00701-019-04097-8","article-title":"Quantitative measurement of the surgical freedom for anterior communicating artery complex\u2014a comparative study between the frontotemporal pterional and supraorbital craniotomy; a laboratory study","volume":"161","author":"Cheng","year":"2019","journal-title":"Acta Neurochir (Wien)."},{"issue":"3","key":"R13-20250821","first-page":"1276","article-title":"Comparative anatomical analysis between the minipterional and supraorbital approaches","volume":"134","author":"Martinez-Perez","year":"2020","journal-title":"J Neurosurg."},{"issue":"2 suppl operative","key":"R14-20250821","first-page":"364","article-title":"Lateral supraorbital approach vs pterional approach: an anatomic qualitative and quantitative evaluation","volume":"68","author":"Salma","year":"2011","journal-title":"Neurosurgery."},{"issue":"5","key":"R15-20250821","doi-asserted-by":"crossref","first-page":"975","DOI":"10.3171\/2009.10.JNS09435","article-title":"Image-guided anatomical and morphometric study of supraorbital and transorbital minicraniotomies to the sellar and perisellar regions: comparison with standard techniques","volume":"113","author":"Beretta","year":"2010","journal-title":"J Neurosurg."}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1227\/ONS.0000000000000044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:03:29Z","timestamp":1786122209000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1227\/ONS.0000000000000044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,22]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1227\/ons.0000000000000044","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,22]]},"assertion":[{"value":"2021-05-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}