The view from above looking into the frontal base also known | Figure 1

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The Bifrontal Craniotomy

The view from above looking into the frontal base also known as the orbital roof. This is the bifrontal craniotomy in which access to the subfrontal region, frontal sinus is needed in for example: tumor or trauma. This technique is not utilized as much as prior having been replaced in my hospital by nasal endoscopic approaches which are less invasive. Still the anatomy is unique with the crista galli differentiating the midline and anchoring the falx separating right from left frontal lobes. In trauma the crista is often fractured.

Similar cases

\n\n13 yo Female, fell from a single storey house. The bone fragment is displaced across the midline from the fracture site, but no tract is evident in the left frontal lobe.

\n\n3 wks into treatment for infections, patient presents again with fever and d/c from wound. Repeat MRI shown. Note that the area in the frontal cortex continues to look like evolving sequelae from contusions, however there is a more sinister appearing area now in the basal ganglia, frontal and temporal lobes suspicious for #glioma. Due to infection, trauma and multiple craniotomies, was not able to be resected for 9 months. Partial resection completed, pathology was #IDHmutant #anaplasticastrocytoma. Started Chemo/Radiation. Other images of surgical bed & traumatic injuries 19 mo post trauma.

\n\nSagittal image from a contrast-enhanced head CT shows a prefrontal soft tissue mass (yellow arrow), opacification of the frontal sinus (red arrow), and a small locule of air deep to frontal bone at the soft tissue mass. The findings are typical of Potts Puffy Tumor. Potts puffy tumor is a complication of acute sinusitis with a subperiosteal subcutaneous abscess and osteomyelitis. The frontal sinus is the most common originating site of infection. #NeuroWednesday

\n\nFibrous osteodisplasia of frontal bone. MRI T1