Abstract
Introduction A variety of dural openings are described for frontal–temporal and cranio-orbital
craniotomies. As with any surgical technique, the goal is to optimally and safely
address the pathology, minimize normal anatomy disruption, and optimize postoperative
recovery. This study reports a modified dural opening for frontal–temporal approaches
which minimizes brain exposure while facilitating visualization for neoplastic and
vascular lesions of the anterior clinoid, supra- and parasellar and adjacent regions.
Methods A sample case is presented for which a low subfrontal dural exposure was utilized
for tumor resection. The clinical presentation, surgical procedure, and outcome are
summarized including a video detailing the surgical technique.
Results A 63-year-old female with gradual left eye vision loss and tumor enlargement on serial
imaging. The small dural-based tumor arose from the left anterior clinoid and optic
canal region compressing the optic nerve. The video shows a left frontal–temporal
craniotomy used to perform extradural anterior clinoidectomy and optic canal decompression.
The novel low subfrontal dural opening without fixed brain retraction allowed dural
opening around the optic canal and clinoidectomy region to resect tumor and complete
optic nerve decompression. Postoperatively, the patient did well with significant
recovery of vision and follow-up at 2.5 years shows no evidence of tumor recurrence.
Conclusion The novel low subfrontal dural opening provides access to lesions of the supra-and
para-sellar and adjacent regions, and preservation of much of the dura avoids some
of the risks of intradural dissection including Sylvian fissure dissection and brain
retraction
The link to the video can be found at: https://youtu.be/Jc7wvR4PTFk.
Keywords
low subfrontal approach - meningioma - anterior clinoid process - extradural dissection
