Cosmetic osteoplastic craniotomy with a chisel and hammer

BACKGROUND Osteoplastic craniotomy has been performed recently with microfi xation systems such as miniplates, burr hole buttons, and/or ceramic dust. However, these are costly methods of treatment. Without the use of these de vices, we performed cosmetic osteoplastic craniotomy using an inexpensive c hisel and hammer. METHODS Our osteoplastic craniotomy with a chisel and hammer was used on 19 lesions in 15 patients. Using a chisel, the bone flap was cut gently from the calvarium to the skull base, the lamina externa to the diploe (finally the lamina interna), and both ends to the midportion between two holes. The lamina interna in the cranium was trimmed easily after removal of the bone flap. The bone defect was minimal because of the absence of a narrow cutti ng groove and because craniectomy was not performed. The bone flap was repl aced by tapping and was tightly fixed. No special fixation system was neede d, except for threads. RESULTS Follow-up (mean follow-up, 5 months; range, 5 weeks to 9 months) sk ull X-ray and SD-CT showed good fusion and inherent normal configuration of the bone flap. There were two minor dural tears and two minor bony fractur es. CONCLUSION A good cosmetic effect without the use of any additional instrum ents was accomplished with osteoplastic craniotomy using a chisel and hamme r. (C) 1999 by Elsevier Science Inc.