Minimizing Invasiveness in Neurosurgical Osteotomies: A Comparative Histomorphometric Study of Piezoelectric Craniotomy versus High-Speed Drill

Background Piezoelectric bone cutting has gained popularity in neurosurgical osteotomies due to perceived lower trauma compared to rotary instruments. However, histological confirmation of its decreased aggressiveness is lacking, hindering conclusive proof. This study compares the bony and neuro-meningeal invasiveness of piezoelectric craniotomy with high-speed drill techniques. Methods Histological data from 21 sheep undergoing piezoelectric craniotomy and 19 sheep subjected to high-speed electric drill craniotomy were compared. Piezoelectric craniotomy utilized a 0.35 mm micro saw titanium nitride coated. Outcome parameters included the detection of the "smear layer," average osteoblast count per high-power field, and residual bone matrix for bony invasiveness assessment. Parameters for meningeal and brain parenchymal invasiveness included pachymeningeal and leptomeningeal injury, gliosis, and histiocytic infiltration. Statistical significance was determined at P < 0.05. Results Results showed the Piezo group had fewer frequent smear layers (P <0.001), higher residual bone matrix (P < 0.05), and greater osteoblast counts per high-power field (P < 0.05). Additionally, the Piezo group exhibited lower rates of leptomeningeal injury, cerebral gliosis, and histiocytic infiltration (P < 0.05). Conclusions Piezoelectric craniotomy preserves residual osteoblast viability and leptomeningeal integrity while demonstrating lower rates of thermally induced gliosis and histiocytic infiltration compared to high-speed drills. This suggests the piezoelectric osteotome's minimal invasiveness in bone, meningeal, and brain tissue.