Current methods for brow fixation: are they safe?

Area of Science:

• Anatomy
• Neurosurgery
• Plastic Surgery

Background:

• Forehead-lift fixation techniques lack universal acceptance.
• Current methods carry risks like alopecia, implant issues, and dural injury.

Purpose of the Study:

• To anatomically evaluate calvarial thickness at key brow fixation points.
• To compare the cranial penetration depth of various fixation techniques.

Main Methods:

• Calvarial thickness was measured in 14 cadavers at specific points (A-F).
• Fixation techniques including cortical tunnels, screws (2.0-mm, Mitek, Endotine), and miniscrews were simulated.
• Penetration depth and inner table breach potential were assessed.

Main Results:

• Posterior and medial calvarial sites (C-F) were thickest.
• Female skulls were significantly thicker than male skulls.
• Cortical tunnels and Mitek screws did not penetrate the inner table; one Endotine device and three miniscrews did.

Conclusions:

• Calvarial thickness varies by anatomical site and gender, with posterior/medial sites and female skulls being thicker.
• Certain fixation techniques, like cortical tunnels and Mitek screws, appear safer regarding inner table penetration.
• Surgeons must consider calvarial anatomy to minimize risks like cerebrospinal fluid leak during brow fixation.