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External frontal bone transillumination for frontal sinus mapping in anterior skull base surgery: technical note
1Department of Neurosurgery, ASST Lecco - Ospedale "Alessandro Manzoni", Via dell'Eremo 12/14, Lecco, 23900, Italy. l.fiori@asst-lecco.it.
Neurosurgical Review
|June 8, 2026
Summary
External frontal bone transillumination offers a simple method for intraoperative frontal sinus mapping in skull base surgery. This technique accurately identifies frontal sinus boundaries, optimizing surgical windows and minimizing bone removal.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Accurate identification of frontal sinus boundaries is crucial for anterior skull base surgery.
- Optimizing the surgical bony window and minimizing bone removal are key goals.
Purpose of the Study:
- To present a straightforward and repeatable technique for intraoperative frontal sinus mapping using external frontal bone transillumination.
Main Methods:
- External frontal bone transillumination involves applying a fiber-optic light cable to the frontal squama under low light.
- The frontal sinus appears as a translucent area, delineating its margins.
- Postoperative CT scans confirm the accuracy of the intraoperatively identified boundaries.
Main Results:
- The technique was successfully used in 14 patients undergoing anterior skull base surgery.
- External transillumination clearly identified frontal sinus margins, aiding in creating adequate surgical windows.
- Postoperative imaging validated the accuracy of the sinus opening, with no observed complications.
Conclusions:
- External frontal bone transillumination is a simple, rapid, and dependable method for intraoperative frontal sinus mapping.
- It serves as a valuable adjunct to preoperative imaging for enhancing surgical exposure in skull base procedures.
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