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Comparative Analysis of Disposable Cranial Perforators in Trepanation
Kazufumi Ohmura1,2, Noriyuki Nakayama1, Tsuyoshi Izumo1
1Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
Neurosurgery Practice
|October 30, 2025
Summary
Comparing disposable cranial perforators, ACRA-CUT is fastest but costly and risks dural injury. MERIDIAN offers a safer balance for routine neurosurgery, while Codman is cost-effective but less efficient.
Area of Science:
- Neurosurgery
- Surgical Instrumentation
- Medical Device Evaluation
Background:
- Disposable cranial perforators are crucial for modern neurosurgical procedures like cranial trepanation.
- Advancements aim to improve safety, efficiency, and cost-effectiveness in these procedures.
Purpose of the Study:
- To evaluate and compare the safety, efficiency, and cost-effectiveness of three disposable cranial perforators: Codman, MERIDIAN, and ACRA-CUT.
- To assess clinical outcomes and structural characteristics of different perforator designs.
Main Methods:
- Retrospective analysis of 129 cranial trepanations using Codman, MERIDIAN, and ACRA-CUT perforators.
- Assessment of trepanation success rates, operative times, and complication rates.
- Cadaveric study on dural integrity at varying angles and digital microscopy for structural analysis.
Main Results:
- ACRA-CUT demonstrated the fastest trepanation times (11.8s) and highest success rate (100%), but at a higher cost and increased risk of dural injury at oblique angles.
- MERIDIAN showed a high success rate (97.7%) with moderate speed (26.4s) and lower cost, presenting a balanced profile.
- Codman was cost-effective but had the lowest success rate (69%) and longest operative time (74.6s).
Conclusions:
- ACRA-CUT excels in speed but requires careful use due to cost and dural injury risk.
- MERIDIAN is recommended as a safer option for routine neurosurgical procedures.
- Codman's limitations in success rate and operative time warrant consideration, with further randomized studies needed for optimal perforator selection.
