The utility of a threadwire saw during craniotomy: Technical note

Titanium plates have been frequently used for the rigid internal fixation of bone flaps in cranial surgery, in order to prevent the flap from sinking. The cost of the instruments, however is prohibitive and may cause some neurosurgeons to hesitate using them. We propose performing craniotomies using a threadwire saw (T-saw), which has been primarily devised for spinal surgery. The T-saw comprises a stainless steel blade that has a fine diameter, highly flexible properties and a relatively smooth surface when compared with the Gigli saw, although both apparatii are used in the same manner. These characteristics lead to less damage to the soft tissue and negligible cutting loss. The T-saw craniotomy also brings an oblique cutting edge in the cranial window, which enables the surgeons to drill the inner table away while leaving the outer table preserved, as required. This advantage, as well as the negligible cutting loss, permits a good fitting and fixation of the bone flap with only some silk threads. The T-saw is a cost-effective and useful apparatus for cranial as well as spinal surgery.