Reconstruction of craniotomy burr-holes with compressed autologous bone dust

In this simple technique, as you can see in the following video, there are 4 steps:

1. Carefully collect all the bone dust while you are performing the drilling.

2. Bone dust moistened whit saline solution is inserted into a disposable 5 ml syringe and the endpiece is removed with a scalpel

3. Pressing a gauge at the opening and at the same time firmly compressing the  piston of the syringe, until the excess of the saline solution is squeezed out from the syringe

4. The obteined bone mass is inyected into the burr-hole and once the cavity is filled the bone dust is cut by sliding the syringe firmly on the surface of the skull


You need to a flashplayer enabled browser to view this video (english) (spanish)

I have been using this technique since I was in my second training year program (2006), and the aesthetic result are acceptable, no infection rates. I consider is a cheap, accesible and fast technique to prevent the cavities and skindents specially in the frontal area.

This simple technique is part of my (M.E.N) Minimally Expensive Neurosurgery program, performed in a public hospital where access to medical supplies are really limited, but not putting aside the goal of achieving a successful outcome of all our procedures.

Comments to

Edgar M. Carrasco

Santa Cruz - Bolivia

Comments (6)Add Comment

No burr holes please
written by sharmakchand, May 29, 2011
Please see karam Chand method of craniotomy. The burr holes in neurosurgery nee d to be stopped for all times to come. A small craniotomy with 1.5 or 2 cm trephine having adjustable dura guard and serves the same purpose and you can replace the same entirely ensuring that no calvarial defect is left. I have a brief video on to demonstrate trephine craniotomy. Sice I have invented this trephine in 1.5 to 5.25 centimeter having adjustable dura guard, I never had to do a burr hole in last 2 years. This can easily become part of any drill but I like it with Hudson brace. I also cut calvarial bone from outside to inside by making deep grooves with small burr or drill, and by making a small opening with 1.5 cm trephine at one edge of craniotomy the dura can be separated from overlying bone ,and final cut can be made with my special chisel or small chisel or drill itself by putting a dissector beneath the bone groove to protect dura.
written by carrascoem, May 29, 2011
Dr. Karam if you tell us how can we get your trephine, be sure than more than one of us will use your craniotomy method.
Warm regards
Edgar M. Carrasco
written by Thomas S, May 29, 2011
Thank you very much for presenting this very interesting technique and the very illustrative video! I have some questions:

Do you notice any raised problems with infections using the bone dust?
Any cases where you avoid using this this procedure (for example meningeoma involving the skull bone or open skull fracture)?
How do you fixate the bone flap?

Best Regards,
Thomas Skoglund
written by sharmakchand, May 30, 2011
Respected Sir,
Please send an email to addressed to Mr Anil, asking for Karam Chand trephine and Scalp retractor. This is based in Delhi and this company makes lots of other neurosurgical instruments. Please search also fourbhai udyog in delhi. This is another manufacturer of my trephine and retractor. If it does not work, contact me, I will arrange to supply you. Again thanks for your video. It seems you have same aim as me, to do refined neurosurgery in an economic way.
Dr Thomas
written by carrascoem, June 05, 2011
I have not had infection problems, anyway saline solution we use for irrigation has gentamicyn.

I have used this technique since 2006 and have more than 30 selected patients, in most of them a pterional approach have been performed for an aneurysm and some skull base tumours. This technique was used only in patients who doesn't have health insurance who pays a craniofix or another closure system, and the bone dust was used as an alternative to prevent skindents in the frontal area. No cases of meningioma involving calvaria or trauma surgery were included.

In the selected patients the craniotomy was performed with a Gigli saw, I prefer this technique instead of craniotomy with drill because two reason, the narrow bone gap is minimal and you can bevel the borders of the bone flap, so when is time to fix the bone flap is easier because it lays by itself on the border of the calvaria, and I fix them with a non-absorbable suture

Thank you for the interest

Edgar M. Carrasco
good results
written by doctormido, January 02, 2013
burr holes, with reconstruction with bone dust has good result specially in frontal burr holes and in bald patients,also avoid the pulsating dura appearance which may be awful to the patient

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