Craniotomy using image-guided oscillating saw: technical note.
OBJECTIVE
To describe a new craniotomic technique that eliminates burr holes and minimizes bone loss along the craniotomic line.


METHODS
Fifty burr hole free craniotomies were performed in varied locations using an image-guided micro-oscillating saw. Care was taken to avoid cutting the inner cortical layer. Upon completing the micro-oscillating saw cut the inner table could then be gently fractured along the craniotomic line with a thin bladed osteotome. Simple silk sutures were used to resecure the bone flap.


RESULTS
The craniotomic time required for this procedure ranged from 7 to 24 minutes (mean: 13 minutes). We observed no dural lacerations or signs of brain damage in any of these procedures. The use of image guidance allows a continuous measure of bone thickness along the craniotomic line. In all of the cases we report the cosmetic result was excellent.


CONCLUSIONS
This alternative technique of craniotomy can be used in selected cases to achieve excellent cosmetic results which avoid the time and cost of complex reconstruction techniques.
Department of Neurosurgery, Istituto Nazionale Neurologico ''C. Besta'', Milan, Italy. pferroli@istituto-besta.it
Paolo
P
Ferroli
Angelo
A
Franzini
Marcello
M
Marchetti
Elio
E
Maccagnano
Giovanni
G
Broggi
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology / Q000601:surgery; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001930:Brain Injuries / Q000517:prevention & control; D002648:Child; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods*; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation* / Q000379:methods*; D012886:Skull / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments / Q000592:standards / Q000639:trends*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000639:trends; D016896:Treatment Outcome