# One-piece bifrontal basal craniotomy with pericranial flap for frontal sinus management: How I Do It

## TL;DR

A new surgical technique for anterior skull base surgery improves outcomes by reducing CSF leakage and preserving appearance.

## Contribution

A novel one-piece bifrontal basal craniotomy with pericranial flap is introduced for frontal sinus management.

## Key findings

- The technique reduces cerebrospinal fluid leakage risks.
- Cosmetic and functional outcomes are preserved with durable reconstruction.
- Miniplates and screws stabilize the reconstruction while avoiding infection risks.

## Abstract

Anterior skull base surgery poses challenges including cerebrospinal fluid (CSF) leakage and cosmetic concerns. A novel one-piece bifrontal basal craniotomy using a pericranial flap was developed to improve outcomes.

The technique included precise burr hole placement, dura-protective craniotomy, and frontal sinus sealing using a pericranial flap. Reconstruction was stabilized using miniplates and screws, leaving the epidural dead space unfilled and lowering infection risks.

This method reduces CSF leakage, enhances reconstruction durability, and preserves cosmetic and functional outcomes, offering a reliable approach for anterior skull base surgery.

The online version contains supplementary material available at 10.1007/s00701-025-06528-1.