Preservation of the olfactory tract in bifrontal craniotomy

Abstract

The anterior cranial base and the suprasellar and parasellar region approach and its several methods have been described since 1981 by Suzuki et al. [ 3, 14, 15 ]. Extended frontal approaches, however, necessitate removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia, cerebrospinal fl uid (CSF) leak, and the need for complex reconstruction of the frontal fl oor [ 11, 12 ]. Bifrontal craniotomy is the conventional approach to lesions in these locations [ 10, 11 ], but its shortcoming has been the damage to the olfactory tract [ 7 ]. The preservation of the olfactory tract has been the subject of many studies in extended frontal approaches. Fujiwara et al. [ 7 ] and Eriksen et al. [ 4 ] reported various cases of anosmia after anterior communicating artery aneurysm surgery. Spetzler et al. [ 5, 12 ] modifi ed the technique of handling the cribriform plate to preserve the olfactory unit. Srinivasan et al. [ 5, 13 ] described the bifrontal approach that enhanced the exposure of the suprasellar region and minimized the manipulation of the optic apparatus and the carotid arteries.