Open Access
CC BY-NC-ND 4.0 · Arch Plast Surg 2023; 50(03): 248-253
DOI: 10.1055/s-0042-1758543
Pediatric/Craniomaxillofacial/Head & Neck
Idea and Innovation

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

Hiroyuki Koizumi 
1   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Daisuke Yamamoto 
1   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Hajime Handa 
1   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Wakiko Saruta 
1   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Satoru Shimizu
2   Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan
,
Takuichiro Hide 
1   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Toshihiro Kumabe 
1   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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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

© 2023. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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