Abstract
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.
References
Chibbaro S, Makiese O, Bresson D, Hamdi S, Cornelius JF, Guichard JP, Reiss A, Bouazza S, Vicaut E, Ricci A, Galzio R, Poczos P, George B, Marsella M, Di Emidio P (2011) Skull bone flap fixation—reliability and efficacy of a new grip-like titanium device (Skull Grip) versus traditional sutures: a clinical randomized trial. Minim Invasive Neurosurg 54:282–285. https://doi.org/10.1055/s-0031-1297246
Winston KR, Wang MC (1999) Cranial bone fixation in infants and children. Pediatr Neurosurg 31:225–230
Winston KR, Wang MC (2003) Cranial bone fixation: review of the literature and description of a new procedure. J Neurosurg 99:484–488. https://doi.org/10.3171/jns.2003.99.3.0484
Van Loock K, Menovsky T, Kamerling N, De Ridder D (2011) Cranial bone flap fixation using a new device (Cranial LoopTM). Minim Invasive Neurosurg 54:119–124. https://doi.org/10.1055/s-0031-1283171
Broaddus WC, Holloway KL, Winters CJ, Bullock MR, Graham RS, Mathern BE, Ward JD, Young HF (2002) Titanium miniplates or stainless steel wire for cranial fixation: a prospective randomized comparison. J Neurosurg 96:244–247. https://doi.org/10.3171/jns.2002.96.2.0244
Gupta R, Adeeb N, Griessenauer CJ, Moore JM, Patel AS, Thomas AJ, Ogilvy CS (2016) Removal of symptomatic titanium fixation plates after craniotomy. Acta Neurochir 158:1845–1848. https://doi.org/10.1007/s00701-016-2929-7
Takahashi N, Fujiwara K, Saito K, Tominaga T (2015) Interdigitated craniotomy: a simple technique to fix a bone flap with only a single plate. J Neurosurg 123:1055–1058. https://doi.org/10.3171/2014.10.JNS141034
Lemcke J, Meier U, Al-Zain F (2009) The clinical application of a new absorbable fixation clamp in craniotomy closure. A technical note after first experiences with 29 patients. Acta Neurochir 151:1231–1234. https://doi.org/10.1007/s00701-009-0361-y
Spetzler RF (1997) Bone flap fixation: a new technique. Technical note. J Neurosurg 87:475–476. https://doi.org/10.3171/jns.1997.87.3.0475
Acknowledgements
We wish to thank Ms. Zoya Khan, a medical student working in our department, who provided the illustration included in this article (Fig. 3).
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Singh, N., Steinbok, P. Craniotomy bone flap fixation: revisiting the use of bone struts. Childs Nerv Syst 34, 1235–1239 (2018). https://doi.org/10.1007/s00381-017-3620-x
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DOI: https://doi.org/10.1007/s00381-017-3620-x