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  • Surgical trephines designed to cut circular sections of the skull. These devices are typically handheld, manual instruments with two coaxial drills and a drive shank attached to an integral T-shaped handle for manipulation (i.e., application of torque); some instruments include a graduated scale on the cutting cylinder. Typically, the external cutting blade has a circular-saw-like working edge and the internal blade at the center is used for guiding purposes. Some trephines have detachable blades and a manually operated (i.e., a hand brace) or power (e.g., electrical) rotary handpiece. Skull surgery trephines are used to open small holes in the cranium for insertion of catheters and/or encephaloscopes for diagnosis or treatment purposes, such as to alleviate intracranial pressure, obtain cerebrospinal fluid samples, and inject radiopaque dyes. Automated powered devices (known as cranial perforators) are more frequently used for skull perforation than manually propelled trephines; dedicated hand drills including guards and/or footplates are also used to perform craniotomy.
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