Our Summary

This research paper discusses a common type of skull surgery called fronto-temporo-orbito-zygomatic (FTOZ) craniotomy. This method has been developed over time from a similar surgery called pterional craniotomy, and there are different versions of it that doctors use depending on their personal preference and the specific needs of the patient.

The FTOZ craniotomy is useful because it gives surgeons access to different parts of the skull, including the orbit (eye socket), and it’s a good option for treating complex issues in the skull. This paper looks at two versions of this surgery, the one-piece and two-piece FTOZ craniotomy, and discusses the pros and cons of each.

The authors also include a visual guide to the cuts made during both methods. The goal of the paper is to give a better understanding of FTOZ craniotomy and how it can be used to treat complex skull problems with minimal disruption to the brain.

FAQs

  1. What is a fronto-temporo-orbito-zygomatic (FTOZ) craniotomy and when is it used?
  2. What are the differences between the one-piece and two-piece FTOZ craniotomy?
  3. How does an FTOZ craniotomy minimize disruption to the brain while treating complex skull problems?

Doctor’s Tip

A doctor might tell a patient undergoing a craniotomy to make sure they follow all pre-operative instructions, such as fasting before surgery and avoiding certain medications. It is important to have a thorough discussion with the surgeon about the procedure and any potential risks or complications. After surgery, it is important to follow all post-operative care instructions, including taking prescribed medications and attending follow-up appointments. It is also important to allow time for rest and recovery to ensure the best possible outcome.

Suitable For

Patients who may be recommended for a craniotomy include those with:

  1. Brain tumors: Craniotomy may be recommended to remove tumors located deep within the brain or close to critical structures.

  2. Traumatic brain injuries: In cases of severe head trauma, a craniotomy may be necessary to relieve pressure on the brain and reduce the risk of further damage.

  3. Aneurysms: Craniotomy may be performed to repair aneurysms or arteriovenous malformations (AVMs) in the brain.

  4. Epilepsy: In some cases, a craniotomy may be recommended for patients with epilepsy that does not respond to medication, in order to remove the area of the brain causing seizures.

  5. Hydrocephalus: Craniotomy may be performed to place a shunt or perform a ventriculostomy to drain excess cerebrospinal fluid from the brain.

  6. Skull fractures: In cases of severe skull fractures, a craniotomy may be necessary to repair the damage and prevent further complications.

  7. Infections: Craniotomy may be recommended to remove infected tissue or drain abscesses in the brain.

It is important to note that each patient is unique, and the decision to undergo a craniotomy will depend on the individual’s specific condition and medical history. The risks and benefits of the procedure should be carefully weighed by a team of healthcare professionals before proceeding with surgery.

Timeline

Before a patient undergoes a craniotomy, they will typically undergo a series of tests and evaluations to determine the best course of action for their specific condition. This may include imaging tests such as CT scans or MRI scans, as well as blood tests and other diagnostic procedures.

On the day of the surgery, the patient will be admitted to the hospital and prepared for the procedure. This may involve fasting, receiving medications, and meeting with the surgical team to discuss the surgery and ask any questions.

During the surgery, the patient will be placed under general anesthesia. The surgeon will then make an incision in the scalp and remove a portion of the skull to access the brain. The specific steps of the surgery will vary depending on the reason for the craniotomy, but the goal is typically to remove a tumor, repair a blood vessel, or address other issues in the brain.

After the surgery, the patient will be monitored closely in the intensive care unit or a regular hospital room. They may experience pain, swelling, and other side effects, but these can typically be managed with medication. The length of the hospital stay will vary depending on the complexity of the surgery and the patient’s overall health.

In the weeks and months following the craniotomy, the patient will have follow-up appointments with their medical team to monitor their recovery and address any complications. Physical therapy, speech therapy, and other interventions may be recommended to help the patient regain function and improve their quality of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about craniotomy include:

  1. What specific type of craniotomy will be performed on me? (e.g. FTOZ craniotomy, pterional craniotomy)
  2. What are the risks and potential complications associated with this type of craniotomy?
  3. What is the expected recovery time after the surgery?
  4. Will I need any additional treatments or therapies after the craniotomy?
  5. How long will I need to stay in the hospital after the surgery?
  6. What are the expected outcomes of the surgery in terms of symptom relief or improvement?
  7. Will there be any long-term effects or restrictions following the craniotomy?
  8. How experienced is the surgical team in performing this type of craniotomy?
  9. Are there any alternative treatment options to consider before proceeding with the craniotomy?
  10. What can I do to prepare for the surgery and optimize my recovery afterwards?

Reference

Authors: Folse MS, Jee E, Talbot NC, Petty CF, Luther PM, Kandregula S, Guthikonda B, Savardekar AR. Journal: World Neurosurg. 2024 Jul;187:35-41. doi: 10.1016/j.wneu.2024.03.132. Epub 2024 Mar 27. PMID: 38552789