Comparative Analysis of Disposable Cranial Perforators in Trepanation

BACKGROUND AND OBJECTIVES: Cranial trepanation is a fundamental neurosurgical procedure that has evolved significantly with the development of disposable cranial perforators designed to enhance safety and efficiency. The aim of this study was to evaluate and compare the safety, efficiency, and cost-effectiveness of disposable cranial perforators used in neurosurgical procedures. METHODS: A retrospective analysis was conducted on 129 trepanations performed by a single surgeon between May and December 2024, using 3 disposable cranial perforators: Codman (Integra LifeSciences Production Corporation), MERIDIAN (adeor medical AG), and ACRA-CUT (ACRA-CUT Inc.). Clinical parameters assessed included trepanation success rates, operative times, and complication rates. In addition, a cadaveric study examined the impact of varying drilling angles on dural integrity. Structural distinctions among perforators were investigated using digital microscopy. RESULTS: ACRA-CUT was approximately twice as expensive as Codman and MERIDIAN. Clinically, Codman demonstrated the lowest success rate (69%) compared with MERIDIAN (97.7%) and ACRA-CUT (100%). ACRA-CUT also achieved the shortest median trepanation time (11.8 seconds) compared with Codman (74.6 seconds) and MERIDIAN (26.4 seconds). However, the cadaveric analysis revealed a higher incidence of dural injury with ACRA-CUT at oblique angles. Structural analysis highlighted ACRA-CUT's distinctive acute tip and tri-curved blade design, correlating with its superior performance but an increased risk profile. CONCLUSION: ACRA-CUT offers unparalleled efficiency and speed, but its high cost and greater propensity for dural injury at nonperpendicular angles necessitate cautious application. MERIDIAN emerges as a safer choice for routine procedures, whereas Codman, despite being cost-effective, is hindered by its lower success rate and potential for prolonged operative times. Further randomized studies are warranted to validate these findings and optimize perforator selection.