Craniotomy bone flap fixation: revisiting the use of bone struts.

INTRODUCTION

Bone flap fixation after craniotomy is a standard part of neurosurgical practice. Several techniques and devices exist, though no ideal strategy has been identified. The key aims are to prevent infection and to achieve adequate cosmesis and bony fusion whilst also minimising costs and complications. Ease of use must also be considered. Fixation with sutures and bony struts in the kerf has been described in children and adults and, although the technique achieves many of the ideals of fixation, it does not seem to have been popularised. We report our experience of using the strut technique.

METHODS

A retrospective review of our cranial surgery database, operative notes and follow-up records was conducted. 300 applicable craniotomies were carried out in 8 years. Struts were used in 81 cases and comments on the bony contour described in 21 follow-up records.

RESULTS

In nineteen, the contour was perfect. In one, there was a small bony depression; and in one, there was a small ridge in the posterior part. No repeat operations were carried out for surgery or cosmesis.

CONCLUSIONS

We report our results with a view to reminding the neurosurgical community of the existence of a technique that achieves all the criteria of the ideal fixation strategy.