Optimized Bifrontal Craniotomy: Reducing Risks and Boosting Surgical Results

Bifrontal craniotomy is one of the most common surgical approaches for dealing with anterior skull base lesions. However, this procedure occasionally present complications like anosmia, cerebrospinal fluid (CSF) leakage, infection, and cosmetic problems. Although previous reports suggested various solutions, there remains a need to further refine the procedure to ensure better outcomes. In this paper, we introduce our revised method and examine the clinical results. Our protocol pays attention to preventing avulsion of the olfactory bulb by brain movement, such as avoiding preoperative administration of hyperosmotic diuretic solution, mobilizing the olfactory tract from the frontal lobe base, and fixing the olfactory bulb to the cribriform plate. On opening, the frontal sinus mucosa is separated from the bone components and pushed into the frontonasal duct. After removing the inner table, the frontal sinus is completely covered by the pericranial flap. To prevent cosmetic problems, a Gigli wire saw is used to cut the supraorbital edge to minimize the bone defect. Surgical complications in 38 patients who underwent bifrontal craniotomy using these methods in our institute from 2005 to 2020 were investigated. Only one case (2.6%) experienced postoperative anosmia. There were no cases of CSF leakage, infections, or cosmetic problems. Through diligent practices and attention to minute details, such as gentle manipulations to preserve the olfactory nerve, reliable procedures for frontal sinus closure, and maximum attention to esthetic results, surgical techniques can be refined and developed to the level of highly skilled expertise with low rate of complications.