The advantage of the Gigli saw in performing mid-frontobasal craniotomy over the power driven tools.

he mid-frontobasal approach can be carried out with the help of several tools, thanks to the technical improvements in the neurosurgical field. Cutting thick bone is one of the drawbacks of the power saw, this needs rongeuring of the bone or the use of manual spiral wire with handle.1 The use of the Gigli saw2 requires additional time compared with power-driven drills, however, this is amply compensated at closure, as the need for fixation of the bone flap by wiring or mini-plating is obviated in this bone-sparing technique. The frontal sinus can be opened and closed easily without the need for special maneuvers to plug the sinus, the follow-up of these patients revealed that the sinus becomes aerated without an increase in the incidence of infection or CSF leak. In performing a mid-frontobasal craniotomy, 3 5mm burr-holes are connected. With the use of a conventional guiding probe the Gigli saw is conveyed routinely from one burr-hole to another (Figure 1). A dural dissector can be used before the guiding wire if the frontal dura is fragile and adhesive to the bone. The cut through the bone is sawn obliquely (beveled). Bone cutting by Gigli saw in between burr holes is narrow and beveled, so the flap will sit well without sinking at the end of operation, while the cut made with power drills is wider and beveling may not be possible.3 In order to make the basal cut as low as possible, the dura mater is disengaged from the bone by Penfield #3 and a dural dissector, the guiding probe can be shifted from one burr-hole to another through the cut in between. As the superior sagittal sinus is rudimentary at the level of the crista frontalis the blind dissection is completely safe.4 The bony ridges at the inside of the skull can be passed, and the frontal sinus can be opened as low as possible using the Gigli saw (Figure 2). The mid-Frontobasal approach was used in 23 patients between 10-65 years at King Hussein Medical Center, Amman, Jordan. This approach can be used for different types of pathology in the anterior cranial fossa and suprasellar region (Table 1). Nowadays, power-driven tools are widely used to raise a bone-flap in a short time. However, the bone-flap made by a drill or craniotome requires expensive and time-consuming mini-plating or wiring at closure; this can be a real problem in T