Although simple in its concept, craniotomy can still cause serious consequences to the patient. A recent alternative to standard techniques (i.e. perforator and craniotome) is represented by Piezosurgery (PS) which exploits a microvibrations-emitting blade that cuts the bone directly from the outer surface of the skull. Although PS has already been demonstrated to decrease complications, dural laceration and neurovascular injury are still possible from inadvertent penetration of the inner tabula. Modern neuronavigation systems can provide the surgeon with the possibility to track the instrument while carving the skull, thus potentially lowering complication rates.
Two cases of miretromastoid craniotomies for trigeminal neuralgia were performed with the use of neuronavigated-PS. Before surgery, the patients underwent volumetric brain MRI’s and CT’s scans. The piezosurgical-cutter was registered on the S8 StealthStation neuronavigation system using the step-by-step Medtronic Cranial standard instrument calibration protocol.
The craniotomy was performed with the surgeon visualizing on the neuronavigation monitor both the position and trajectory of the instrument’s blade while penetrating the bone. No dural lacerations or neurovascular injuries were reported. At the end of the procedures the bone flaps were perfectly repositioned within their craniotomic margins without the use of cranial fixation devices.
Neuronavigated-piezosurgery has the potential to decrease craniotomic-related complication rates. By allowing real-time visualization of the blade’s level of penetration, it provides to the surgeon with the ability to halt progression when needed, avoiding dural lacerations and neurovascular injuries. The principles behind such technique could anticipate the advent of robotic-image aided craniotomies.

Copyright © 2021. Published by Elsevier Inc.
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