Skull Base 2011; 21(5): 323-328
DOI: 10.1055/s-0031-1284214
ORIGINAL ARTICLE

© Thieme Medical Publishers

Repositioning of Cranial Bone Flaps Cut with a Diamond-Coated Threadwire Saw: 5-Year Experience with Cosmetic Cranioplasty without Fixation Devices

Satoru Shimizu1 , Koji Kondo1 , Tomoya Yamazaki1 , Kenji Nakayama1 , Isao Yamamoto1 , Kiyotaka Fujii2
  • 1Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Japan
  • 2Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
Further Information

Publication History

Publication Date:
21 July 2011 (online)

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.

REFERENCES

  • 1 Duke B J, Mouchantat R A, Ketch L L, Winston K R. Transcranial migration of microfixation plates and screws. Case report.  Pediatr Neurosurg. 1996;  25 (1) 31-34 discussion 35
  • 2 Lerch K D. 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 (4) 902-905
  • 3 Persing J A, Posnick J, Magge S et al.. Cranial plate and screw fixation in infancy: an assessment of risk.  J Craniofac Surg. 1996;  7 (4) 267-270
  • 4 Winston K R, Wang M C. Cranial bone fixation: review of the literature and description of a new procedure.  J Neurosurg. 2003;  99 (3) 484-488
  • 5 Yaremchuk M J, Posnick J C. Resolving controversies related to plate and screw fixation in the growing craniofacial skeleton.  J Craniofac Surg. 1995;  6 (6) 525-538
  • 6 Shimizu S, Miyazaki T, Suzuki S et al.. Supratentorial craniotomy using a threadwire saw. Technical note.  Neurol Med Chir (Tokyo). 2008;  48 (4) 191-194 discussion 194
  • 7 Spetzler R F. Bone flap fixation: a new technique. Technical note.  J Neurosurg. 1997;  87 (3) 475-476
  • 8 Shimizu S, Hagiwara H, Nakayama K, Fujii K. [Technique for embedding a titanium miniplate in the forehead that avoids objectionable bulges].  No Shinkei Geka. 2009;  37 (1) 43-46
  • 9 Eppley B L, Sadove A M, Havlik R J. Resorbable plate fixation in pediatric craniofacial surgery.  Plast Reconstr Surg. 1997;  100 (1) 1-7 discussion 8-13
  • 10 Weisberger E C, Eppley B L. Resorbable fixation plates in head and neck surgery.  Laryngoscope. 1997;  107 (6) 716-719
  • 11 Noda K, Tanikawa R, Sugimura T et al.. Use of bioabsorbable plates for cranial fixation. Technical note.  Neurol Med Chir (Tokyo). 2009;  49 (11) 559-562
  • 12 Ochiai C, Okuhata S, Yoshimoto Y, Nagai M. Bridged craniotomy for stable fixation of a bone flap. Technical note.  J Neurosurg. 1996;  85 (3) 518-519
  • 13 Tomita K, Kawahara N. The threadwire saw: a new device for cutting bone.  J Bone Joint Surg Am. 1996;  78 (12) 1915-1917
  • 14 Kawahara N, Tomita K, Shinya Y et al.. Recapping T-saw laminoplasty for spinal cord tumors.  Spine. 1999;  24 (13) 1363-1370
  • 15 Tomita K, Kawahara N, Toribatake Y, Heller J G. Expansive midline T-saw laminoplasty (modified spinous process-splitting) for the management of cervical myelopathy.  Spine. 1998;  23 (1) 32-37
  • 16 Iwama T, Yamada J, Imai S, Shinoda J, Funakoshi T, Sakai N. The use of frozen autogenous bone flaps in delayed cranioplasty revisited.  Neurosurgery. 2003;  52 (3) 591-596 discussion 595-596

Satoru ShimizuM.D. 

Department of Neurosurgery, Yokohama Stroke and Brain Center

1-2-1 Takigashira, Isogo-ku, Yokohama 235-0012

Email: Satoru4756@aol.com