Removing Craniofacial Titanium Screws: Technical Note

Craniotomy, cranioplasty, and craniofacial procedures may involve reoperation for additional treatment of the primary pathological condition or treatment of complications, requiring removal of previously placed hardware. During removal of the titanium hardware, there is a risk of losing, dropping, or misplacing the titanium screws because of their small size. There are also instances of difficulty disengaging the screw from the screwdriver. We describe the use of a plastic specimen cup in retrieving titanium screws after detaching them from the screwdriver by screwing the screw into the cup, thus rapidly and safely securing and storing screws for collection/discarding or possible reuse. When the empty screwdriver is used to retrieve and unscrew the titanium screw from the cranial flap or the skull bone, a plastic specimen cup should be placed adjacent to the site of screw removal. Once the screw is removed, while it is still fastened to the screwdriver, it is immediately re-screwed and secured onto the base of the plastic specimen cup, which is then placed into a second plastic specimen cup. This method prevents misplacement or dropping of the screw that may otherwise occur when manipulating the screw on or off the screwdriver and avoids perforating the surgeon's glove during handling. We describe the adjunctive use of a plastic specimen cup when removing cranial screws and hardware to rapidly and safely detach the screw and prevent the misplacement, dropping, or loss of screws intraoperatively that results in additional operative time and personnel assistance.