Gupta et al., report the experience with cranial fixation plate removal because of pain and protrusion in patients who underwent craniotomy without orbitozygomatic osteotomy, particularly frontotemporal craniotomy. In an attempt to reduce this complication, they recently stopped placing a full-size burr hole in the keyhole area of a frontotemporal craniotomy, eliminating the need for a titanium burr hole cover plate 1).

1)
Gupta R, Adeeb N, Griessenauer CJ, Moore JM, Patel AS, Thomas AJ, Ogilvy CS. Removal of symptomatic titanium fixation plates after craniotomy. Acta Neurochir (Wien). 2016 Oct;158(10):1845-8. doi: 10.1007/s00701-016-2929-7. Epub 2016 Aug 12. PubMed PMID: 27520360.