Cosmetic Frontotemporal Craniotomy Using an Osteotome: Technical Note

A frontotemporal craniotomy is usually performed using a “keyhole,” made at the union of the zygomatic arch and frontal bone. Consequently, skull depression may occur postoperatively, leading to temporal area deformities and poor cosmetic results. To prevent these complications, we describe our technique for frontotemporal craniotomy using an osteotome to prevent cosmetic deformities. After the temporal muscle is dissected and reflected with the scalp flap, a total of 3 burr holes are made in the frontal and temporal bones. In the lateral greater wing of the sphenoid, where a keyhole is usually made, a bone incision is made anteriorly-posteriorly with an osteotome. The bone flap is lifted upward, and the osteotome is inserted from behind to continue the incision. At craniotomy closure, the bone flap is fixed using a cranial bone flap fixation clamp. This procedure involves almost no removal of frontal or inferior temporal bone, resulting in virtually no bone defect. The absence of skull depression or deformity in the temples postoperatively leads to excellent cosmetic results. Our technique for frontotemporal craniotomy using an osteotome does not create bone defects, and use of titanium clamps for bone flap fixation provides normal skull bone alignment. This procedure provides excellent postoperative cosmetic results.