Single piece fronto-temporo-orbito-zygomatic craniotomy: a personal experience and review of surgical technique.

Background: Fronto-Temporo-Orbito-Zygomatic (FTOZ) craniotomy has progressed from its humble beginnings. Numerous variations including one piece, two piece and even three piece FTOZ craniotomies have been described. The ideal technique still remains elusive and its use remains restricted to a few specialised centres even when benefits far outweigh the surgical difficulties.

Objective: To analyse 11 cases in which single piece FTOZ craniotomy was used and to review the steps of surgery along with its advantages.

Methods: A total of 11 cases of skull base lesions were operated over a period of 30 months and followed up for a minimum period of 6 months. They were analysed for intraoperative benefits, requirement of cerebral retraction, surgical difficulties, post op recovery, complications faced and post-op cosmetic appearance.

Result: A total of nine cases had tumours of skull base including Spheno-Petro-Clival meningiomas, Trigeminal schwannomas, Solitary fibrous histiocytoma and two had giant aneurysms of P1 segment. Intraoperative cerebral retraction was significantly less. There were two post-op deaths. Three patients had temporary and 1 patient had permanent third nerve deficit. There was no injury to periorbital fat and post op cosmetic appearance was good.

Conclusion: Single piece FTOZ craniotomy is no more difficult than two or three piece craniotomy, rather it facilitates a rapid craniotomy closure with excellent handling of single piece of bone. It provides a wide, multidirectional access to skull base. Lesions become shallow and their access easier. Benefits far outweigh the difficulties if any, and its use should be encouraged even at centres outside of the specialised units.