The frontotemporosphenoidal craniotomy, usually denominated pterional craniotomy, was first described by Yasargil in 1975 and is one of the earliest landmarks of the advents of microneurosurgery [1][2][3] . This approach enables, specifically, the exposure of the entire frontoparietal operculum 4,5 , the opening of the entire sylvian fissure 6,7 and all anterior cisterns of the encephalon base 2,5 , which makes both the pterional craniotomy and the transylvian approach the widest used techniques in today's neurosurgery practice.Over the past decades, the pterional craniotomy has undergone a systematization modified by several authors, what also gave rise to more extended types of craniotomies 8,9 . Among then, the supraorbital craniotomy 10 and the orbitofrontozygomatic craniotomy 10-13 stands out. This review offered a detailed description of the technique we use nowadays for this procedure, with modifications arising from its extensive use since its initial proposal, seeking to optimize all its stages, the access and opening of the cisterns, as well as minimize brain retraction. DESCRIPTION OF PROCEDUREPositioning -the patient should be placed supine, with the shoulder at the edge of the surgical table in a neutral position, and head and neck remain suspended after removal of the head support. The head should be secured by a three-pin skull fixation devise (Mayfield or Sugita model) and must be maintained above the level of the right atrium to facilitate venous return. In order to avoid the head holder position to hinder the surgeon' s procedure, the ipsilateral pin of the operative field should be set on the mastoid region, while the two contralateral pins should be on the contralateral superior temporal line, above the temporal muscle, that should not be transfixed. The pin corresponding to the ipsilateral mastoid and the most anterior one corresponding to the contralateral superior temporal line must be in parallel position to prevent any head movement, especially during future traction of cranial wraps made with the aid of fish-hooks.There is a sequence of five movements for the positioning of the head: traction, lifting, deflection, rotation and torsion. ABSTRACTThis review intended to describe in a didactic and practical manner the frontotemporosphenoidal craniotomy, which is usually known as pterional craniotomy and constitute the cranial approach mostly utilized in the modern neurosurgery. This is, then, basically a descriptive text, divided according to the main stages involved in this procedure, and describes with details how the authors currently perform this craniotomy.Key words: craniotomy, microsurgery, neurosurgery. RESUMOA presente revisão visou descrever de forma didática e prática a realização da craniotomia frontotemporoesfenoidal, usualmente denominada pterional, que constitui a craniotomia mais utilizada na prática neurocirúrgica atual. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas envolvidas na realização desse procedimento, que mostr...

This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.Keywords: neurosurgery, craniotomy, microsurgery, far-lateral approach.RESUMO O presente artigo visa descrever de forma didática e prática a realização da craniotomia suboccipital extremo-lateral. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização dessa craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.Palavras-chave: neurocirurgia, craniotomia, extremo-lateral, microcirurgia.Approaching lesions located in the lower clivus and at the anterior edge of foramen magnum have always presented as a challenge to the neurosurgeon. The majority of these lesions have been approached posteriorly by suboccipital or retrosigmoid craniotomies and anteriorly by trans-oral and through the paranasal sinus approaches. Nevertheless all of then have disadvantages including a great depth of surgical field and an extremely limited lateral exposure 1 . Once the high morbidity and mortality of lesions located at so an important anatomic region, the improvement of these posterior approaches is imperative, in order to increase the surgical exposure and reduce the retraction of neurovascular structures.The far lateral approach is the one composed by the dissection of occipital-cervical muscles with the exposition of suboccipital triangle, the lateral suboccipital craniotomy and finally the exposure of vertebral artery since its entrance into the dura mater 2

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OBJECTIVE The authors report a novel surgical route from a superior anatomical aspect-the contralateral anterior interhemispheric-transcallosal-transrostral approach-to a lesion located in the subcallosal region. The neurosurgical approach to the subcallosal region is challenging due to its deep location and close relationship with important vascular structures. Anterior and inferior routes to the subcallosal region have been described but risk damaging the branches of the anterior cerebral artery. METHODS Three formalin-fixed and silicone-injected adult cadaveric heads were studied to demonstrate the relationships between the transventricular surgical approach and the subcallosal region. The surgical, clinical, and radiological history of a 39-year-old man with a subcallosal cavernous malformation was retrospectively used to document the neurological examination and radiographic parameters of such a case. RESULTS The contralateral anterior interhemispheric-transcallosal-transrostral approach provides access to the subcallosal area that also includes the inferior portion of the pericallosal cistern, lamina terminalis cistern, the paraterminal and paraolfactory gyri, and the anterior surface of the optic chiasm. The approach avoids the neurocritical perforating branches of the anterior communicating artery. CONCLUSIONS The contralateral anterior interhemispheric-transcallosal-transrostral approach may be an alternative route to subcallosal area lesions, with less risk to the branches of the anterior cerebral artery, particularly the anterior communicating artery perforators.