Autogenic bone plug to seal burr holes: technical note.

Many neurosurgical procedures can be performed by a single burr hole: neuroendoscopy, microvascular decompression, stereotactic procedures, chronic subdural haematomas. It is technically difficult to suture and close the dura, located at the bottom of such holes, which can lately lead to CSF leakage. On the other hand, the surgical material used to seal the burr holes can be divided in heterogenic (metal screws, silicon plugs, gelfoam, bone wax, metilmetacrilate, hidroxiapatite), and autogenic (fat, aponeurosis, muscle, and bone dust from trephination). The heterogenic group always brings the possibility of foreign body reaction, which can complicate the procedure lately, ensuing a new surgical procedure to clean up the area. It also favors infection. We present a simple, economic, and biologically compatible "autogenic bone plug" to seal burr holes using the bone dust from the original trephination packed with surgicel. The incidence of CSF fistulae on that procedures performed by a single burr hole lowered to almost zero, and foreign body reaction was not observed to present.