Subfrontal and Bifrontal Craniotomies with or without Orbital Osteotomy

Indications

• The unilateral and bilateral subfrontal approaches are the workhorse approaches for access to nearly the entire anterior cranial fossa floor; anterior midline parasellar structures such as the tuberculum sella, anterior communicating artery, and optic chiasm; posterior orbit; and orbital apex.

• A unilateral subfrontal approach is sufficient for most orbital lesions and midline lesions that are largely eccentric to one side.

• For large or purely midline lesions, the increased flexibility of view provided by a bifrontal approach is preferable.

• In smaller and more posterior lesions or lesions with significant superior extension, removal of the supraorbital bar may reduce retraction-related cortical injury and improve visualization.