Technique for Sylvian Fissure Opening on Pterional Approach: Dissection with the Reverse Plane View of Arachnoid Membrane

Abstract

The pterional approach is a fundamental technique for neurosurgeons, but difficulty for dissection of the sylvian fissure has considerable variety. Establishment of a safe and adequate technique to dissect the sylvian fissure is essential for all neurosurgeons.
We introduce our operative technique for dissection of the sylvian fissure with the reverse plane view of arachnoid membrane and discuss the efficacy of this technique from an anatomical background.
Dissection of sylvian fissure is started from the distal part, where arteries of the M2 segment are seated and adhesion of the frontal and temporal lobe is not so tight. Exposure of space around arteries of the M2 segment is necessary to obtain a direct view to the plane where the frontal and temporal lobe adhere more tightly with dissection progressing more medially. With the reverse plane view of arachnoid membrane of the proximal sylvian fissure, dissection between the frontal and temporal lobe can be achieved safely with a direct view.
Our surgical technique facilitates dissection of the sylvian fissure and prevents damage of surrounding brain and vessels.