title: Repositioning of Cranial Bone Flaps Cut with a Diamond-Coated Threadwire Saw: 5-Year Experience with Cosmetic Cranioplasty without Fixation Devices.
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.
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.forename: Koji
authors.initials: K
authors.lastname: Kondo
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakayama
authors.forename: Isao
authors.initials: I
authors.lastname: Yamamoto
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fujii