Frontotemporal orbitozygomatic (FtOZ) craniotomy evolved from the pterional approach. In the pterional approach, following frontotemporal craniotomy and sphenoid bone drilling, access is gained to the Sylvian fissure, a natural corridor between the frontal and temporal lobes, and from there to the circle of Willis. This approach can be conceived as a skull base extension of the pterional approach. Since the early twentieth century, studies have described the supraorbital approach [1]. However, during the 1980s, some neurosurgeons began publishing a modified approach derived from pterional craniotomy, expanding it to the orbital and zygomatic regions. This modification enabled broader skull base access while minimizing brain retraction [2–6].