Oh, the wonders of modern neurosurgery, where we can now poke around the brain with the finesse of a minimally invasive approach, like the lateral supraorbital approach (LSO). It’s like the pterional approach went on a diet and came back sleeker, ready to tackle everything from aneurysms that aren’t playing hard to get to tumors throwing a party around the sellar region.

Here’s the recipe: make a dainty skin incision behind the hairline to keep things pretty, create a one-layer myocutaneous flap and gently persuade it to move forward, and then drill a modest 4 cm hole—just enough to say hello to the brain without being rude. The Sylvian fissure is your VIP pass to the anterolateral skull base, but don’t get too excited; it’s not an all-access pass.

Now, for the thrilling part: potential party crashers. You might accidentally RSVP the frontal sinus or the orbit, and nobody wants orbital fat at their soiree. And if you mess up the location, well, that’s just embarrassing. Plus, if you’re stingy with the craniotomy size, your instruments might throw a fit from lack of dancing space.

To avoid these social faux pas, you’ll need to be a bit of a brainiac—know your landmarks, close up any sinuses you didn’t mean to invite, study those CT scans like they’re juicy gossip, and maybe bring along a neuronavigation system as your plus-one.

But wait, there’s more! The LSO doesn’t play nice with everyone. It’s a bit snobbish towards the temporomesial region and some aneurysms with a medial projection. For those, we roll out the red carpet with an extended LSO, drilling through the sphenoid wing like it’s a grand entrance.

And because we’re thorough, we might even do a little intradural or extradural clinoidectomy, because why not go the extra mile?

Lastly, let’s not forget the patient, who bravely consented to this brainy adventure and the sharing of their headshot. Cheers to them for being the life of the party! 🥂