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Kevin T. Foley, Eric J. Woodard, Jonathan R. Slotkin, Cassandra K. Mayotte, Abigail C. Baldwin, Michael C. Brown and Brian J. Hess

T itanium plates and screws are the current state-of-the-art devices for cranial bone flap fixation. They occasionally loosen, resulting in hardware protrusion, cosmetic disfiguration, or pain, and can require reoperation. 5 , 9 Bone cements have been suggested as an alternative to metal for cranial fixation, but existing cements have not replaced hardware, primarily because they lack sufficient strength for this application. 4 Currently available cements are also not chemically adhesive, do not provide a water-tight seal, and add significant cost to the

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Rohit Khanna, Lisa Ferrara and Sohit Khanna

restrict the extent of intracranial volume expansion. 7 , 9 , 10 , 14 , 17 , 20 , 21 More recently the procedure of dynamic craniotomy has been introduced, which involves fixating the bone flap with plates that allow for outward movement with brain swelling or increase in intracranial volume but also prevent the bone flap from sinking inside the skull. 12 Dynamic craniotomy involving cranial bone flap fixation with reversibly expandable low-profile plates provides another option in the management of postoperative complications related to brain swelling or intracranial

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Robert F. Spetzler

✓ A new fixation technique for bone flaps is described. This technique avoids the use of hardware external to the skull in hairless areas where it may prove unsightly in patients with a thin scalp. The insertion of pins into the middle table of the skull firmly fixes bone flaps at one edge, eliminating the need for external plates at that site.

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William C. Broaddus, Kathryn L. Holloway, Charles J. Winters, M. Ross Bullock, R. Scott Graham, Bruce E. Mathern, John D. Ward and Harold F. Young

used. More recently, advancing technology in the manufacture of miniplate fixation systems has provided alternative means of bone flap fixation. 1, 3, 6, 8–10, 12 Many surgeons now prefer this method because it provides more readily for optimal positioning of the bone flap with substantial rigidity. In addition, miniplates configured to cover burr holes allow bone fixation while avoiding scalp indentations that can be palpable or visible postoperatively. Unfortunately, the cost of using these systems is considerably higher than alternatives such as stainless steel

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Ken R. Winston and Marjorie C. Wang

bone shim method for cranial flap fixation was used successfully in 386 (99.7%) of 387 consecutive craniotomies in adults. The only failure occurred in a patient at high risk (sclerotic, irradiated site with bone nonunion of 14 years' duration). The bone shim method of fixation uses the kerf to advantage in establishing architectural stability with multisite, bone-to-bone abutment via bone shims, instead of ignoring the kerf and allowing it to be a site of prolonged structural weakness and vulnerability ( Fig. 3 ). The absorbable sutures prevent the shims from being

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tightly packing into the surrounding kerf the shims of bone that are harvested from the under edge of the free bone flap and then securing the flap with absorbable sutures. The result is a keystone arrangement that locks the flap into the craniotomy site. Conclusions. The bone shim method for cranial bone fixation was used successfully in 386 of 387 consecutive craniotomies in adults. This procedure for cranial flap fixation is reliable, safe, and rapid, and it achieves solid structural stability with excellent esthetic results. No special tools are required, and

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Noboru Takahashi, Kazunori Fujiwara, Keiichi Saito and Teiji Tominaga

interdigitated craniotomy between January 2014 and May 2014. Lesions included 8 anterior circulation aneurysms and 1 putaminal hemorrhage. The quality of the bone flap fixation was assessed at least 3 months after the surgery. At the hairless area, the positioning of the bone flap with respect to the height of its surface relative to the surface of the adjacent bone (offset) was assessed by appearance and palpation. The patient characteristics and results of the follow-up assessment are provided in Table 1 . Excellent results were achieved in all patients, except for 1

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Brandon G. Rocque, Bonita S. Agee, Eric M. Thompson, Mark Piedra, Lissa C. Baird, Nathan R. Selden, Stephanie Greene, Christopher P. Deibert, Todd C. Hankinson, Sean M. Lew, Bermans J. Iskandar, Taryn M. Bragg, David Frim, Gerald Grant, Nalin Gupta, Kurtis I. Auguste, Dimitrios C. Nikas, Michael Vassilyadi, Carrie R. Muh, Nicholas M. Wetjen and Sandi K. Lam

.17–2.19 0.45  Spinal cord injury 10.97 0.12 to >999.9 0.30 Reason for craniotomy 0.4076 1.0  Closed head injury Ref Ref Ref  Open head injury 0.74 0.21–2.59 0.64  Ischemic stroke 0.71 0.16–3.10 0.65  Rupture of vascular lesion 0.92 0.39–2.16 0.84  Metabolic abnormality 1.10 0.01–102.68 0.97  Other 0.95 0.30–2.98 0.93 Method of bone flap storage 2.7601 0.25  Frozen Ref Ref Ref  Abdominal pocket 0.211 0.01–4.57 0.32  No stored bone 0.39 0.10–1.53 0.18 Method of bone flap fixation 8.5055 0.04  Suture 3.32 1.29–8.54 0.01  Titanium plates Ref Ref Ref  Resorbable plates 2.20 1

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chronic subdural hematoma Juei-Jueng Lin Dar-Cheng Chang September 1997 87 3 474 474 10.3171/jns.1997.87.3.0474 Bone flap fixation: a new technique Robert F. Spetzler September 1997 87 3 475 476 10.3171/jns.1997.87.3.0475 Charles Labbé (1851–1889) Ronald H. M. A. Bartels Jacobus J. Van Overbeeke September 1997 87 3 477 480 10.3171/jns.1997.87.3.0477 J Neurosurg Journal of Neurosurgery 0022-3085 Journal of Neurosurgery Publishing Group 1 9 1997 September 1997 87 3 10.3171/jns.1997

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Sung Bae Park, Tae-Ahn Jahng, Chi Heon Kim and Chun Kee Chung

positioning of the laminar flap. The time required for laminar flap fixation with translaminar screws is comparable to that required to place a microplate. F ig . 3. Schematic views depicting lumbar laminoplasty procedures. A: The laminectomy was performed over the intraspinal pathological level. B: After completion of the intraspinal surgery, a hand-held 2.4-mm drill was used to drill the intralaminar hole at the spinolaminar junction through the slope of the contralateral lamina (bilaterally). Subsequently, screws were inserted into the thoracic and lumbosacral