Bifrontal Craniectomy: A High-Yield Surgical Training Tool

Bifrontal decompressive craniectomy (DC), which was once a popular technique for treating midline mass lesions, has seen a notable decline in its therapeutic use within modern neurosurgery. Despite its diminished clinical use, the procedure offers considerable value as an educational tool for surgical training. This study used a Thiel-embalmed cadaver to demonstrate the bifrontal DC procedure, including a Souttar incision, strategic (MacCarty, zygomatic, and apical) keyhole/burr hole placement, superior sagittal sinus suturing, left frontal lobe decortication, and microscopic visualization of the anterior cranial fossa. The procedure demonstrated educational value in three ways: first, wide anatomical exposure enables a detailed discussion of tissue handling. Second, an efficient training paradigm that allows multiple surgical techniques to be taught within a limited timeframe. Third, it offers risk management training focusing on superior sagittal sinus protection. While bifrontal DC has selective therapeutic applications, its potential as a teaching tool is undervalued. The procedure's wide exposure creates an ideal platform for surgical education, allowing residents to develop skills in a structured environment. We advocate its use in training programs by focusing on its educational benefits rather than its limited therapeutic role.