ABSTRACT
Artificial fixation systems for cranial bone flaps have problems related to their
materials and designs. We developed an alternative technique for supratentorial craniotomy
that employs a diamond-coated threadwire saw (diamond T-saw), originally developed
for spinal surgery, and reduces the bone gap for fitted bone flap fixation. The study
subjects were 77 adults undergoing elective supratentorial craniotomy. After placing
a burr hole at each corner of the craniotomy, we performed osteotomy between adjacent
burr holes to approximately one-third of the length of the osteotomy with a craniotome;
this leaves a bony bridge at each corner. The diamond T-saw was introduced between
adjacent burr holes through the epidural space and a bridge was cut with reciprocating
strokes. On closure, the bridge firmly supports the flap and only sutures are needed
for fixation. Successful bone flap fixation was obtained in all followed-up cases.
There were no technique-related complications such as dural laceration, flap displacement,
or resorption. Our method is ideal for bone cuts in cosmetic cranioplasty; it is easy,
safe, and inexpensive and avoids the need for flap fixation with artificial devices.
KEYWORDS
Craniotomy - cranioplasty - diamond threadwire saw
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Satoru ShimizuM.D.
Department of Neurosurgery, Yokohama Stroke and Brain Center
1-2-1 Takigashira, Isogo-ku, Yokohama 235-0012
eMail: Satoru4756@aol.com
