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Craniotomy Revisited: Techniques for Improved Access and Reconstruction

Published online by Cambridge University Press:  04 August 2016

Michael D. Cusimano  and
Agustinus S. Suhardja
Michael D. Cusimano*
Affiliation:
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Agustinus S. Suhardja
Affiliation:
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
*
Division of Neurosurgery, St. Michael's Hospital, 38 Shuter Street, Toronto, Ontario M5B 1A6, Canada.
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Abstract:

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Objective:

To describe simple modifications of the technique of opening and closure of the craniotomy to improve basal exposure and reconstruction.

Methods:

The modifications involve: a) additional soft-tissue dissection which is carried downward to the base of the ear and to the orbital rim, exposing the orbital rim and malar eminence without removing the bone; b) cutting the bone flap so that ‘bridges’ of bone remain that help to stabilize the flap when it is returned to the cranium at the end of the operation; c) the wedging of bone chips between the bone flap and native cranium at the time the bone is being reaffixed so as to provide firm stability by diminishing movement of the bone flap; d) the use of bone dust and bone chips mixed with the patient's blood to seal and bridge the gap between the bone flap and the native bone; e) reattachment of the temporalis muscle with the bone flap sutures. An ‘inlay’ technique of duraplasty is also described.

Results and Conclusion:

These simple modifications of craniotomy provide better basal exposure and reconstruction with little additional operating time at no additional cost.

Résumé:

RÉSUMÉ:But:

Décrire des modifications simples de la technique d'ouverture et de fermeture de la crâniotomie pour améliorer l'exposition basale et la reconstruction.

Méthodes:

Les modifications impliquent: a) une dissection supplémentaire des tissus mous qui est prolongée vers le bas jusqu'à la base de l'oreille et au bord de l'orbite, exposant le bord de l'orbite et l'éminence malaire sans retirer l'os; b) le découpage d'un volet osseux de telle sorte que des “ponts” osseux demeurent en place pour aider à stabiliser le volet quant il est remis en place à la fin de la chirurgie; c) l'implantation de fragments osseux entre le volet osseux et le crâne natif au moment où l'os est refixé afin de le stabiliser fermement en diminuant le mouvement du volet osseux; d) l'utilisation de poussière d'os et de fragments osseux mêlés au sang du patient pour sceller et remplir l'interstice entre le volet osseux et l'os natif; e) le rattachement du muscle temporal avec les sutures du volet osseux. Une technique d'“incrustation” pour la plastie de la dure-mère est également décrite.

Résultats et Conclusion:

Ces modifications techniques simples améliorent l'exposition basale et la reconstruction tout en prolongeant peu le temps opératoire, sans augmenter les coûts de la crâniotomie.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 1 , February 2000 , pp. 44 - 48
Copyright
Copyright © The Canadian Journal of Neurological 2000

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