Craniotomes

Craniotomes are surgical instruments used to cut skull bone in neurosurgical procedures, most commonly during craniotomy or craniectomy to provide access to intracranial structures. They are designed to create precise bone cuts while protecting surrounding soft tissues.

Most craniotomes are powered devices, though manual variants exist. A typical instrument consists of a handle, a blade or rotating saw, and a guard or depth-control feature. Powered models may be electric, pneumatic, or battery-driven and use reciprocating or rotating blades. Blades are available in various sizes and configurations to suit different skull regions and planned margins. Modern craniotomes often employ irrigation to cool bone and reduce heat generation during cutting.

Use and technique: After exposure of the skull and initial burr holes or skeletonization around the intended craniotomy margins, the craniotome is used to connect the burr holes and complete the bony cut to detach a bone flap. In trauma or certain pathologies, a craniectomy may require more extensive bone removal. Care is taken to stay near the dura to minimize dural or brain injury, and the bone flap is typically replaced and secured after the intracranial work is completed.

Safety and alternatives: Potential risks include thermal injury to bone and adjacent tissues, dural tears, frontal or cortical injury, and bleeding. Alternatives or adjuncts include manual osteotomes, Gigli saws, and other craniotomy instruments. The choice of instrument depends on surgeon preference, skull thickness, and anatomical considerations.