CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 581-586
DOI: 10.1055/s-0043-1772759
Original Article

Analysis of the Variations in the Morphology, Topography of the Pterion, and Their Implications in Neurosurgery: An Osteometric Study

Navita Aggarwal
1   Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, India
,
Noopinder Kaur
2   Department of Anatomy, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
,
1   Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, India
,
Monika Gupta
2   Department of Anatomy, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
› Institutsangaben
Funding None.

Abstract

Objective Pterion is an “H” shaped formation of sutures located in the temporal fossa of the skull. It is an important anatomical landmark and a craniometric point. The thinness of the skull and its inner relation with the middle meningeal artery make this anatomical landmark clinically significant. Variations in the pterion are imperative, especially for neurosurgeons in order to have the most suitable craniometric point to be minimally invasive.

Materials and Methods One hundred pterions were studied to report the variations in the type and location of the pterion. Murphy's classification was used to classify the pterion into four types on the basis of bone articulation-sphenoparietal, frontotemporal, stellate, and epipteric.

Results All four types of pterions were observed, sphenoparietal being the most common. No significant gender difference was observed in terms of type and laterality of various pterions. The mean distance between the center of pterion to the superolateral point of zygomaticotemporal (PZT) suture and the anterolateral point of the frontozygomatic (PFZ) suture were 3.91 ± 3.79 cm and 3.68 ± 3.79 mm, respectively. Correlation analysis showed a strong positive relation between PZT and PFZ sutures.

Conclusion Accurate data on the morphology and morphometry of bony anatomical points are crucial, while performing intracranial surgery using them as recognizable landmarks. The morphometric parameters may help in determining the soundness of the pterion as an identifiable landmark for performing interventions like burr hole and other neurosurgical procedures in this area.

Authors' Contributions

N. Aggarwal helped in project development, data collection, and manuscript writing; Noopinder Kaur contributed to data collection and manuscript writing; A Patra was involved in data analysis and manuscript editing; Monika Gupta wrote the manuscript.




Publikationsverlauf

Artikel online veröffentlicht:
31. August 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Seema D, Dakshayani KR, Sumanth MM. A morphometric study of pterion in adult human skulls. Int J Sci and Tech. 2013; 9 (01) 112-115
  • 2 Snell RS. Clinical Anatomy by Regions. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2003: 790-920
  • 3 Yameen M, Haider SS, Nagwani M. et al. The morphological analysis of pterion in North Indian population. Eur J Med Res 2018; 5 (02) 1-4
  • 4 Halim A. Surface and Radiological Anatomy. 2nd ed. New Delhi: CBS Publishers & Distributors; 1993
  • 5 Bhargavi C, Saralaya V, Kishan K. Pterion. A site for neurosurgical approach. Int J Biomed Res 2011; 2 (12) 588-594
  • 6 Standring S, Ellis H, Healy JC, Johnson D, Williams A. Eds. Gray's Anatomy – The Anatomical Basis of Clinical Practice. 39th ed. Churchill Livingstone, London: Elsevier; 2005: 455-459
  • 7 Shah AS, Shah SK, Bhaskar R. et al. Morphometric study of pterion in adult dry skulls in Dakshina Kannada district Karnataka state, India. Int J Anat Res. 2015; 3 (04) 1603-1606
  • 8 Rafi A, Sayeed S, Anwar MI. Cranial CT scan evaluation of morphological variations and location of pterion in Pakistani male population for lateral neurosurgical approach. Pak J Med Sci 2020; 36 (03) 310-315
  • 9 Saxena RC, Bilodi AK, Mane SS, Kumar A. Study of pterion in skulls of Awadh area–in and around Lucknow. Kathmandu Univ Med J 2003; 1 (01) 32-33 (KUMJ)
  • 10 Murphy T. The pterion in the Australian aborigine. Am J Phys Anthropol 1956; 14 (02) 225-244
  • 11 Saheb SH, Haseena S, Prasanna LC. Unusual Wormian bones at pterion – three case reports. J Biomed Sci and Res. 2010; 2 (02) 116-118
  • 12 Kumar S, Anurag Munjal S, Chauhan P. et al. Pterion its location and clinical implications – a study compared. J Evol Med Dent Sci 2013; 2 (25) 4599-4608
  • 13 Kamath V, Asif M, Bhat S. et al. A study on the pterion position variation and its neurosurgical implications. J Anat Soc India 2016; 65 (01) 33-39
  • 14 Kalthur SG, Vangara SV, Kiruba L. et al. Metrical and non-metrical study of the pterion in South Indian adult dry skulls with notes on its clinical importance. Marmara Med J. 2017; 30: 30-39
  • 15 Oguz O, Sanli SG, Bozkir MG, Soames RW. The pterion in Turkish male skulls. Surg Radiol Anat 2004; 26 (03) 220-224
  • 16 Mwachaka PM, Hassanali J, Odula P. Sutural morphology of the pterion and asterion among the adult Kenyans. Braz J Morphol Sci 2009; 26 (01) 4-7
  • 17 Adejuwon SA, Olopade FE, Bolaji M. Study of the location and morphology of the pterion in adult nigerian skulls. ISRN Anat 2013; 403937
  • 18 Ruiz CR, Souza GC, Scherb TO. et al. Anatomical variations of pterion: analysis of the possible anatomical variations of pterion a human skull. J Morphol Sci. 2016; 33 (04) 200-204
  • 19 Chaijaroonkhanarak W, Woraputtaporn W, Prachaney P. et al. Classification and incidence of pterion patterns of Thai skulls. Int J Morphol 2017; 35 (04) 1239-1242
  • 20 Sarvaiya BJ, Chaudhari JS, Fichadiya NC. Morphometric analysis of pterion in adult human dry skull in Gujarat region. Int J Anat Res. 2019; 7 (1.2): 6204-6210
  • 21 Gindha GS, Mir NS, Agarwal R. Morphometric study of pterion in dry human skull bone in north Indian population. Human Bio Rev. 2017; 6 (01) 1-9
  • 22 Prasad H, Bezbaruah NK, Mishra A. et al. Morphometric analysis of pterion: a clinic- anatomical study in north Indian dry skulls. Innovative Journal of Medical and Health Science. 2015; 5 (05) 201-205
  • 23 Reis BL, Silveira RLD, Gusmão SNS. Sphenopterional point: strategic point for burr role placement in frontotemporal craniotomies. World Neurosurg 2017; 105: 399-405
  • 24 Kamath VG, Hande M. Reappraising the neurosurgical significance of the pterion location, morphology, and its relationship to optic canal and sphenoid ridge and neurosurgical implications. Anat Cell Biol 2019; 52 (04) 406-413
  • 25 July J, Wahjoepramono EJ. Neurovascular Surgery - Surgical Approaches for Neurovascular Diseases. 1st ed. Singapore: Springer; 2019
  • 26 Gupta R, Sinha MB, Aggarwal A. et al. Landmarks for keyhole neurosurgical procedures through pterion. Int J Health Biomed Res. 2014; 2 (04) 168-173
  • 27 Sindel A, Ogut E, Aytac G. et al. Morphometric study of pterion. Int J Anat Res. 2016; 4 (01) 1954-1957
  • 28 Nayak G, Mohanty BB, Das SR. Morphometric study of pterion and its clinical significance. Asian J Pharm Clin Res 2017; 10 (10) 142-144