gms | German Medical Science

Approaches to the skull base should give a maximum of overview and operating range for large skull base lesions, tumors or trauma. For the bifrontal craniotomy, which consists of only one bone piece, an instrument is desirable that does bonecutting without hurting the underlying structures, particularly the superior sagittal sinus. In order to achieve a satisfying esthetical result in the frontal area, capillary bone cutting geometry was preferred, but until now this was not practicable with the existing craniotomes. The piezo-ultrasound-device (Fa. Mactron) was supposed to fullfill these demands.

6 patients with different diseases (trauma, tumor) were operated via bifrontal transsinal osteotomy performed with the piezo-osteotom (piezo-ultrasound-device by Fa. Mactron). No burrholes were made in the frontal region to prevent drafting skin. The frontal incisionwas performed in a tangential geometry comparable to an architrav in order to diminish the bone cleft and prevent sagging of the bony shell, directly over the superior sagittal sinus. In the lateral and the posterior region, the incision was placed beside the superior sagittal sinus and the Midas osteotom was used to save time.

No sinus injury took place, in the frontal region a very fine osteotomy could be performed without any loss of esthetics by depression at bone defects. We could pass on osteosynthesis anterior while having an optimal fitting. In an observation period of 6 months, all patients showed excellent postoperative wound healing and esthetic results. One patient with diabetes in a poor general condition had a bone infection after 7 months, with osteolysis. At the explantation of the infected bone, it was apparent that the bone has recovered completely in the area of the piezo-osteotomy in contrast to the region where the midas-drill was used.

The concise bifrontal transsinal approach for the reduction of fractured frontal skull base or large tumors is comfortable. A disadvantage is the amount of time necessary for the osteotomy. Therefore we perform the piezo-osteotomy only in sensitive regions, where a sinus could be injured for example. The esthetic result and the bone consolidation after osteotomy in the frontal region is considerably improved. Therefore we regard the piezo-ultrasound-device as superior to conventional tools. The sawing tips should be optimized for the larger area of application in order to increase the removal rate.