One-Piece versus Two-Piece Fronto-Temporo-Orbito-Zygomatic Craniotomy: A Narrative Overview of Evolution.

The fronto-temporo-orbito-zygomatic (FTOZ) craniotomy is a commonly utilized surgical approach for many complex skull base lesions, especially lesions traversing skull base compartments. This craniotomy has evolved over multiple stages, originating from the classic pterional craniotomy and has undergone many variations over time. The FTOZ craniotomy provides access to the orbit as well as to multiple compartments in the cranium (anterior, middle and upper third posterior cranial fossae). The one-piece and two-piece fronto-temporo-orbito-zygomatic craniotomies are two particularly notable variations that have stood the test of time. Selection between the two variations is mostly surgeon preference and comfort with the technique; however, there are few clinical and anatomic studies that have both shaped these craniotomies as well as provided immense information about instances in which they are most useful. The authors review the origin and history of the one-piece and two-piece fronto-temporo-orbito-zygomatic craniotomy and deliberate their advantages and disadvantages. Additionally, a pictorial review has been crafted to clearly illustrate the osteotomies to be made in the FTOZ craniotomy.