Low-Profile 1-Piece Bifrontal Craniotomy for Anterior Skull Base Approach and Reconstruction
- 1 January 2010
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Craniofacial Surgery
- Vol. 21 (1), 233-238
- https://doi.org/10.1097/scs.0b013e3181c5a217
Abstract
Objective: The anterior skull base is a location of many pathologic lesions. These pathologic lesions are treated by bifrontal craniotomy and anterior skull base approach, either primarily or combined with facial osteotomies. To obtain wide exposure, low-profile craniotomies are preferred. In this article, we attempt to describe our own technique of frontal craniotomy for anterior skull base approach. In this technique, the frontal bone, frontal sinus, and the superior supraorbital bar are elevated in en bloc fashion. Methods: Bicoronal skin incision is followed by dissection and retraction of the skin flap in the epigaleal plan. The pericranial galeal flap is dissected separately in subperiosteal fashion until the superior orbital rim. After dissection and retraction of the tip of the temporal muscles, bilateral pterional key burr holes and 1 or 2 parasagittal burr holes are opened. The sagittal burr hole(s) is placed in the point where the upper horizontal surface of the frontal bone slopes vertically downward the forehead. With the craniotome rotating tip (Midas F2/8TA23, Medtronic Inc, Ft Worth, TX), bone cut is made between the pterional key burr holes, passing through the superior orbital bar and the anterior wall of the frontal sinus. To minimize the brain retraction, the operating microscope is placed beside the head, and exposure from the lateral view angle is obtained. Reconstruction of the defect is performed by using pericranial galeal flap and/or Cortoss (Orthovita, Malvern, PA). Results: With this approach, wide exposure of the anterior skull base pathologic lesions was achieved with minimal brain retraction. In the postoperative period, patients tolerated this approach well with favorable functional and cosmetic outcomes. No infections or adverse effects related to this technique or Cortoss were observed. Conclusions: Anterior skull base pathologic lesions can be widely exposed by low-profile bicoronal craniotomy and anterior skull base approach with minimal brain retraction. This wide exposure allows us to gain more control of the pathologic lesion with better resection and reconstruction, reflected on the prognosis of the patients.Keywords
This publication has 41 references indexed in Scilit:
- Use of Cortoss for reconstruction of anterior cranial base: a preliminary clinical experienceEuropean Journal of Plastic Surgery, 2005
- Simple reconstruction of frontal sinus opened during craniotomy using small autogenous bone piece: Technical noteSurgical Neurology, 2003
- Carbonated Apatite and Hydroxyapatite in Craniofacial ReconstructionArchives of Facial Plastic Surgery, 2003
- Evaluation of the reaction kinetics of CORTOSSTM, a thermoset cortical bone void fillerBiomaterials, 2003
- Use of titanium mesh for reconstruction of large anterior cranial base defectsJournal of Neurosurgery, 2000
- Osteoconductivity and bone-bonding strength of high- and low-viscous bioactive bone cementsJournal of Biomedical Materials Research, 1999
- Free Rectus Abdominis Muscle Flap for the Treatment of Complications After Neurosurgical ProceduresThe Journal of Craniofacial Surgery, 1996
- A new bioactive bone cement consisting of BIS‐GMA resin and bioactive glass powderJournal of Applied Biomaterials, 1993
- Free Rectus Abdominis Muscle Flap Reconstruction of the Middle and Posterior Cranial BasePlastic and Reconstructive Surgery, 1986
- Use of the Galeal Frontalis Myofascial Flap in Craniofacial SurgeryPlastic and Reconstructive Surgery, 1986