Two-Part Parasagittal Craniotomy: Technical Note.

Abstract

Introduction: Craniotomy along the midline can be done in a variety of ways. Methods include single piece craniotomy with burr holes on the midline, crossing the midline with footplates of drills using drilled troughs or bilateral burr holes, and craniotomies in multiple pieces. The authors describe a two-part parasagittal craniotomy useful for safely exposing the midline for parasagittal and inter-hemispheric lesions. Methods: The two-part parasagittal craniotomy begins with anterior and posterior burr holes 1.5 cm lateral to the midline. Once the first bone flap is removed, the dura is dissected under direct vision from the inner table of the skull crossing the midline over to the contralateral side for the second part bone flap. In this way, the superior sagittal sinus (SSS) is dissected and protected. Bony reconstruction and closure is straightforward using recessed screws and plates as well as hydroxyapatite for filling in gaps in the bone. Results: The two-part parasagittal craniotomy has been used in more than 200 patients in the last 24 years. During this time, no direct significant laceration of the SSS has occurred due to a dural tear in the anterior, middle, or posterior thirds while completing the craniotomy. The authors recommend this technique as an option for craniotomy around the midline of the supratentorial cranial vault. Conclusions: The two-part parasagittal craniotomy is an option for opening the skull around the midline of the cranial vault for pathologies along the midline and inter-hemispheric fissure. Surgeons can consider this as an option to a one piece bone flap crossing midline.