Last Updated: March 2, 2020
Pathologies that are positioned on one or both side(s) of the falx along the anterior fossa can be reached surgically through either the unilateral anterior parasagittal route or a combination of the supraorbital, pterional, and orbitozygomatic approaches. However, this type of unilateral approach may not provide adequate exposure of large midline lesions, especially tumors with extradural extension into the ethmoid and sphenoid sinuses.
Although more expanded variations of the bifrontal approach involving mobilization of bilateral orbital rims have been described, I do not believe such osteotomies are necessary; they do not significantly broaden tumor exposure since tumor enucleation often affords additional operative working space. Moreover, these osteotomies may be associated with increased risks of cosmetic deformity and cerebrospinal fluid (...