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Introduction: Skull trepanation is an ancient and often religious act found in remains from around the world. However, cranioplasty for the surgical treatment of skull pathologies is a relatively recent phenomenon. In this paper, we focus on the account of skull injury and cranioplasty in medieval Persia., Materials and Results: Herein, we describe and translate the over 500-year-old writings of the Persian physician Baha al-Dowleh Razi regarding cranioplasty in an excerpt from his book entitled Khulasat al-Tajarib (Summary of Experiences). This early writer detailed the methods and indications for cranioplasty including the use of xenographs. Additionally, we attempt to trace this early understanding of skull surgery and follow its possible spread to Europe., Conclusions: It is such early experiences and methods of cranial surgery on which we base our current understanding of neurosurgery.

The frontotemporal, so-called pterional, approach has evolved with the contribution of many neurosurgeons over the past century. It has stood the test of time and has been the most commonly used transcranial approach in neurosurgery. In its current form, drilling the sphenoid wing as far down as the superior orbital fissure with or without the removal of the anterior clinoid, thinning the orbital roof, and opening the Sylvian fissure and basal cisterns are the hallmarks of this approach. Tumoral and vascular lesions involving the sellar/parasellar area, anterior and anterolateral circle of Willis, middle cerebral artery, anterior brainstem, upper basilar artery, insula, basal ganglia, mesial temporal region, anterior cranial fossa, orbit, and optic nerve are within the reach of the frontotemporal approach. In this article, we review the origins, evolution, and modifications of the frontotemporal approach and update the discussion of some of the related derivative procedures.