Whoever invented burr holes has done a great dis service to neurosurgeon.. As of today cosmetic appearance is not of great concern to many neurosurgeons. Large skull flaps are still being made and in which ever way you do it a burr hole by perforator or drill is the first essential stop. Believe me you can do away with it. Just make 1.5 cm trephine with Karam Chand trephine which is having adjustable dura guard so that you can replace all the bone. Even in posterior fossa do craniotomy. I am regularily using 3 cm trephine craniotomy for acoustic tumours.

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Dear Dr Sharma!

I am sure your instrument is monumental in its applications but we should refrain from making such wide generalizations that all neurosurgery should go burr-hole-less!!! There still are, and probably will always be, situations where we do not have an alternative to burr holes. Stereotactic procedures are one of many examples.

I am interested in seeing your trephine. Can you please show some photographs of the instrument?
Best regards

Dear Nasir,

Thanks for your comments. It is hard to believe that burr holes can be replaced. I have also been doing same thing for last few years. A drill blade for single craniotomy costs more than 100 dollars and there is no way other than making a small hole in skull to begin with. But I have found a way out. Today also one of my colleague made 1.5 cm trephine(instead of burr hole) for image guided biopsy of posterior corpus callosum glioma and entire bone was replaced at end of surgery. What we have been doing today is just following trend set by someone more than100 years ago. We have to change and I know it is really difficult to get your concepts accepted. I think you know about Mirza Ghalib about whom other poets of that time said' Kehte hain ke Ghalib ka hain andajen vyan kuchh aur" and that too after a long time when he got accepted in King's durbar.

Happy new year, keep in touch!
Dr Karam Chand Sharma


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