The pterional approach (PA), popularized by Yaşargil almost 40 years ago, stands as one of the most versatile neurosurgical techniques because it allows access to virtually any intracranial lesion located within reach of the circle of Willis.1 When performing any anterolateral approach (e.g., pterional or orbitozygomatic), 2 fundamental principles must be followed: preservation of the frontotemporal branch (FTB) of the facial nerve2 and prevention of temporal muscle atrophy.3 Injury to the FTB results in cosmetic defects due to facial asymmetry and eyebrow raise impairment due to orbicularis oculi, supercilli corrugator, and frontalis muscle palsy. This damage might occur after direct trauma o during muscle retraction.4

Several techniques have been described to preserve the FTB of the facial nerve and the temporal muscle, while soft tissue dissection is still enough to allow for proper visualization of the pterional region. However, most can be included within these 3 basic categories: 1) myocutaneous dissection,5 which provides the most protection of the FTB, although less pterional exposure is achieved due to a minor capability of muscle mobilization; 2) subfascial dissection6; and 3) interfascial dissection,7 which provides the best pterional exposure but poses the most significant risk for FTB injury.

This manuscript aims to propose a subgaleal preinterfascial dissection (SPD), which we describe as a hybrid technique that provides the advantages of both the myocutaneous and interfascial dissections in that it safely preserves the FTB of the facial nerve and allows for full-scale mobilization of the temporal muscle in a lateral and ventral direction, leaving the pterional region unobstructed.