Pterion Variability: A Morphometric Roadmap for Skull Base Surgery

Background: The pterion is a critical neurosurgical landmark for accessing the anterior and middle cranial fossae. Its anatomical variability, however, can affect the accuracy of surgical exposure and increase the risk of complications. Understanding morphological types and morphometric distances from reliable bony landmarks is essential to optimize surgical planning and improve safety. Methods: Morphological patterns and morphometric distances of the pterion were systematically analyzed across large international datasets. The prevalence of different pterion types was compared among populations, and distances from key surgical landmarks—including the frontozygomatic suture, external acoustic meatus, and zygomatic arch—were calculated to generate reference values of clinical utility. Results: The sphenoparietal type emerged as the most frequent, whereas less common variants such as the epipteric and frontotemporal types displayed marked ethnic variability. Morphometric data provided reproducible surgical coordinates for locating the pterion relative to palpable bony landmarks, facilitating the planning of pterional and orbitozygomatic craniotomies. These findings highlight the need to anticipate anatomical differences when tailoring antero-lateral skull base approaches. Conclusion: This morphometric synthesis underlines the neurosurgical relevance of pterion variability. By offering accurate anatomical coordinates and identifying population-specific patterns, the study provides a practical roadmap to enhance precision, minimize risks, and optimize outcomes in skull base surgery. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany