• Toru Yoshiura, Kojiro Wada, Kosuke Kumagai, Satoru Takeuchi, Terushige Toyooka, Naoki Otani, and Kentaro Mori.
• Department of Neurosurgery, National Defense Medical College, Saitama, Japan. Electronic address: torumiru.neurosurgery@gmail.com.
• World Neurosurg. 2019 Oct 1; 130: 106-109.

BackgroundIncomplete penetration of a burr hole sometimes occurs when performing a craniotomy in elderly patients due to osteoporosis. Completion of the burr hole takes more time and may sometimes cause tearing of the dura mater. We have introduced a small bone piece method that can easily and reliably recover an incomplete burr hole safely.Methods1) Cut out a small bone piece of the outer table of about 5-mm size using a rongeur. 2) Place the small bone piece in the center of the incomplete burr hole. 3) Push on the small bone piece with a craniotome after unlocking the safety stop mechanism. 4) Restart and complete the burr hole with the craniotome.ResultsWe succeeded in 10 of 11 incomplete burr holes. One case that failed had osteoporosis. There were no complications.ConclusionsApplication of the unlocked craniotome on the small bone piece can easily complete the burr hole. Less bone deficit is caused compared with making a new burr hole. In addition, time is saved without changing the attachment, and the burr hole is completed safely. This small bone piece method is effective to recover an incomplete burr hole.Copyright © 2019 Elsevier Inc. All rights reserved.

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