Frontotemporal Craniotomy for Clipping of Unruptured Aneurysm Using a Diamond-Coated Thread Wire Saw and Reconstruction Using Calcium Phosphate Cement without Metal Fixation

Abstract

Metal fixation systems for cranial bone flaps cut by a drill are convenient devices for cranioplasty, but cause several complications. We use modified craniotomy using a fine diamond-coated threadwire saw (diamond T-saw) to reduce the bone defect, and osteoplasty calcium phosphate cement without metal fixation. We report our outcomes and tips of this method. A total of 78 consecutive patients underwent elective frontotemporal craniotomy for clipping of unruptured intracranial aneurysms between 2015 and 2019. The follow-up periods ranged from 13 to 66 months. The bone fixation state was evaluated by bone computed tomography (CT) and three-dimensional CT (3D-CT). The diamond T-saw could minimize the bone defect. Only one wound infection occurred within 1 week postoperatively, and no late infection. No pain, palpable/cosmetically noticeable displacement of the bone flap, fluid accumulations, or other complications were observed. The condition of bone fixation and the cosmetic efficacy were thoroughly satisfactory for all patients, and bone CT and 3D-CT demonstrated that good bone fusion. No complication typical of metal fixation occurred. Our method is technically easy and safety, and achieved good mid-term bone flap fixation in the mid-term course, so has potential for bone fixation without the use of metal plates.

Keywords

calcium phosphate cement - cranioplasty - craniotomy - diamond-coated thread wire saw - metal fixation

Author Contributions

H.K. and S.S. conceptualized the study. H.K., S.S., and T.K. contributed to methodology. T.K. and T.H. did the project administration. D.Y., W.S., and H.H. helped in investigation. W.S. and H.H. collected the data. H.K. and T.K. wrote, edited, and reviewed the original draft. All the authors provided approval of final manuscript.

Ethical Approval

This study was approved by the Kitasato University Hospital Institutional Review Board for Human Research in Sagamihara City, Kanagawa, Japan (B20–344).

Patient Consent

Informed consent was obtained from all individual participants included in the study.

Publication History

Received: 08 March 2022

Accepted: 23 July 2022

Article published online:
10 February 2023

• References

• 1 Smith SC, Pelofsky S. Adaptation of rigid fixation to cranial flap replacement. Neurosurgery 1991; 29 (03) 417-418
• 2 Berryhill WE, Rimell FL, Ness J, Marentette L, Haines SJ. Fate of rigid fixation in pediatric craniofacial surgery. Otolaryngol Head Neck Surg 1999; 121 (03) 269-273
• 3 Gupta R, Adeeb N, Griessenauer CJ. et al. Removal of symptomatic titanium fixation plates after craniotomy. Acta Neurochir (Wien) 2016; 158 (10) 1845-1848
• 4 Yamada SM, Gorai K, Gonda K. Pinwheel-shaped titanium plates should be fixed to the skull using all screw holes to protect the plates from being bent. Case Rep Surg 2019; 2019: 5709285
• 5 Wakui D, Nagashima G, Ueda T, Takada T, Tanaka Y, Hashimoto T. Three cases of scalp rupture and cosmetic deformity caused by a fixation plate after craniotomy. [in Japanese] Jpn J Neurosurg 2012; 21 (02) 138-142
• 6 Noda K, Tanikawa R, Sugimura T. et al. Use of bioabsorbable plates for cranial fixation. Neurol Med Chir (Tokyo) 2009; 49 (11) 559-562
• 7 Wu CM, Chen YA, Liao HT, Chen CH, Pan CH, Chen CT. Surgical treatment of isolated zygomatic fracture: outcome comparison between titanium plate and bioabsorbable plate. Asian J Surg 2018; 41 (04) 370-376
• 8 Shimizu S, Kondo K, Yamazaki T, Nakayama K, Yamamoto I, Fujii K. Repositioning of cranial bone flaps cut with a diamond-coated threadwire saw: 5-year experience with cosmetic cranioplasty without fixation devices. Skull Base 2011; 21 (05) 323-328
• 9 Shimizu S, Miyazaki T, Suzuki S. et al. Supratentorial craniotomy using a threadwire saw. Technical note. Neurol Med Chir (Tokyo) 2008; 48 (04) 191-194 , discussion 194
• 10 Höhne J, Werzmirzowsky K, Ott C. et al. Outcomes of cranioplasty with preformed titanium versus freehand molded polymethylmethacrylate implants. J Neurol Surg A Cent Eur Neurosurg 2018; 79 (03) 200-205
• 11 Novaković N, Malivuković A, Minić L, Lepić M, Mandić-Rajčević S, Rasulić L. Cranial reconstruction using autologous bone and methylmethacrilate. J Craniofac Surg 2017; 28 (04) 877-881
• 12 Blum KS, Schneider SJ, Rosenthal AD. Methyl methacrylate cranioplasty in children: long-term results. Pediatr Neurosurg 1997; 26 (01) 33-35
• 13 Matsuno A, Tanaka H, Iwamuro H. et al. Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 2006; 148 (05) 535-540 , discussion 540
• 14 Gautschi OP, Schlett CL, Fournier JY, Cadosch D. Laboratory confirmed polymethyl-methacrylate (Palacos)-hypersensitivity after cranioplasty. Clin Neurol Neurosurg 2010; 112 (10) 915-916
• 15 Pacheco KA. Allergy to surgical implants. Clin Rev Allergy Immunol 2019; 56 (01) 72-85
• 16 Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: a history and analysis. Neurosurg Focus 2014; 36 (04) E19
• 17 Frederickson AM, Sekula Jr RF. The utility of calcium phosphate cement in cranioplasty following retromastoid craniectomy for cranial neuralgias. Br J Neurosurg 2013; 27 (06) 808-811
• 18 Lerch KD. Reliability of cranial flap fixation techniques: comparative experimental evaluation of suturing, titanium miniplates, and a new rivet-like titanium clamp (CranioFix): technical note. Neurosurgery 1999; 44 (04) 902-905
• 19 Yasuhara T, Murai S, Mikuni N, Miyamoto S, Date I. Japanese national questionnaire survey in 2018 on complications related to cranial implants in neurosurgery. Neurol Med Chir (Tokyo) 2020; 60 (07) 337-350
• 20 Marcacci M, Kon E, Zaffagnini S. et al. Reconstruction of extensive long-bone defects in sheep using porous hydroxyapatite sponges. Calcif Tissue Int 1999; 64 (01) 83-90