Introducing the « J » shaped dural tack-up suture technique when you're missing the right handpiece for the drill bit...

Placing dural tack-up sutures is part of the surgical treatment of cranial epidural hematoma, but it is also very useful to stop untimely epidural bleeding during any craniotomy procedure. Hence, dural tack-up sutures stand among the essential technical skills that should be taught to every neurosurgery resident. Traditional tack-up sutures involve passing a thread suture between the thickness of dura mater and a small hole drilled at the bone edge of the craniotomy flap. Alternative dural tack-up sutures can also be tied up between the dura mater and the galea or pericranium when the proper drill handpiece is missing, for example in surgical teams deployed overseas. With this in mind, we present a new technical tip for dural tack-up sutures, which involves making a « J » shaped cut at the edge of the craniotomy. Passing the thread suture down to the bottom of the « J » provides the bone anchor for the dural tack-up suture. This helpful technique only requires the same drill handpiece that is used to cut the craniotomy bone flap.