Shimizu Satoru, Kondo Koji, Yamazaki Tomoya, Nakayama Kenji, Yamamoto Isao, Fujii Kiyotaka
Skull Base. 2011 Sep;21(5):323-8. doi: 10.1055/s-0031-1284214.
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.
颅骨瓣的人工固定系统在材料和设计方面存在问题。我们开发了一种幕上开颅术的替代技术，该技术采用最初为脊柱手术开发的金刚石涂层线锯（金刚石T锯），并减少了用于适配骨瓣固定的骨间隙。研究对象为77例接受择期幕上开颅术的成年人。在开颅术的每个角钻一个骨孔后，我们用颅骨钻在相邻骨孔之间进行截骨，截骨长度约为三分之一；这样每个角都留下一个骨桥。金刚石T锯通过硬膜外间隙插入相邻骨孔之间，通过往复运动切割骨桥。在关闭时，骨桥牢固地支撑骨瓣，固定仅需缝合。所有随访病例均成功进行了骨瓣固定。没有出现与技术相关的并发症，如硬脑膜撕裂、骨瓣移位或吸收。我们的方法非常适合美容颅骨成形术中的骨切割；它简单、安全、便宜，并且无需使用人工装置进行骨瓣固定。
