Figure 1: Pyramidal-shaped dome osteotomy at the cranial base of the spinous process and central splitting of the spinous process and lamina (partially modified [13], permitted by MIWA-SHOTEN Ltd.).
At first, a pyramidal-shaped dome osteotomy is made at the cranial base of the spinous process to obtain a good visual field. Next, the remaining part of the spinous process is split centrally from its surface and the split portion is connected to the pyramidal-shaped dome.

figure 1