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Usefulness of Laser and Ultrasound Aspirator

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Advances in Vestibular Schwannoma Microneurosurgery

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Abstract

The rationale for laser use in tumor resection is both to allow for “no-touch” cutting and for tissue debulking, with hemostatic benefit. Laser surgery, in general, has shown various advantages, such as reduction of mechanical trauma and intraoperative bleeding. Three types of laser have been successfully used in vestibular schwannoma surgery, potassium titanyl phosphate (KTP-532), CO2, and the novel 2μ-thulium lasers, which has been deemed safe especially in “difficult” conditions (e.g., highly vascularized and hard tumors).

The ultrasound aspirator (USA) is used for tissue fragmentation; modern devices are supposed to leave the neurovascular structures around the surgical site largely untouched. The use of the USA for meatal bone removal has recently been introduced in routine skull base surgery as an alternative to the neurotologic drill. Care must be taken in controlling suction, irrigation, and power settings to obtain ideal results and avoid any damage to surrounding dura and soft tissues; the senior authors of this book suggest the configuration Power:50, Suction:5, Irrigation:5 for debulking and increasing power settings for internal auditory canal unroofing.

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References

  1. Gardner G, Robertson JH, Clark WC, Bellott AL, Hamm CW. Acoustic tumor management—combined approach surgery with CO2 laser. Am J Otol. 1983;5(2):87–108.

    CAS  PubMed  Google Scholar 

  2. Ryan RW, Spetzler RF, Preul MC. Aura of technology and the cutting edge: a history of lasers in neurosurgery. Neurosurg Focus. 2009;27(3):E6.

    Article  PubMed  Google Scholar 

  3. Tew JM, Tobler WD. Present status of lasers in neurosurgery. Adv Tech Stand Neurosurg. 1986;13:3–36.

    Article  PubMed  Google Scholar 

  4. Schwartz MS, Lekovic GP. Use of a flexible hollow-core carbon dioxide laser for microsurgical resection of vestibular schwannomas. Neurosurg Focus. 2018;44(3):E6.

    Article  PubMed  Google Scholar 

  5. Mastronardi L, Cacciotti G, Roperto R, Tonelli MP, Carpineta E, How I. Do it: the role of flexible hand-held 2μ-thulium laser fiber in microsurgical removal of acoustic neuromas. J Neurol Surg B Skull Base. 2017;78(4):301–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mastronardi L, Cacciotti G, Scipio ED, Parziale G, Roperto R, Tonelli MP, et al. Safety and usefulness of flexible hand-held laser fibers in microsurgical removal of acoustic neuromas (vestibular schwannomas). Clin Neurol Neurosurg. 2016;145:35–40.

    Article  PubMed  Google Scholar 

  7. Scheich M, Ginzkey C, Harnisch W, Ehrmann D, Shehata-Dieler W, Hagen R. Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach. Eur Arch Otorhinolaryngol. 2012;269(5):1417–23.

    Article  PubMed  Google Scholar 

  8. Hart SD, Maskaly GR, Temelkuran B, Prideaux PH, Joannopoulos JD, Fink Y. External reflection from omnidirectional dielectric mirror fibers. Science. 2002;296(5567):510–3.

    Article  CAS  PubMed  Google Scholar 

  9. Ibanescu M, Fink Y, Fan S, Thomas EL, Joannopoulos JD. An all-dielectric coaxial waveguide. Science. 2000;289(5478):415–9.

    Article  CAS  PubMed  Google Scholar 

  10. Temelkuran B, Hart SD, Benoit G, Joannopoulos JD, Fink Y. Wavelength-scalable hollow optical fibres with large photonic bandgaps for CO2 laser transmission. Nature. 2002;420(6916):650–3.

    Article  CAS  PubMed  Google Scholar 

  11. Nissen AJ, Sikand A, Welsh JE, Curto FS. Use of the KTP-532 laser in acoustic neuroma surgery. Laryngoscope. 1997;107(1):118–21.

    Article  CAS  PubMed  Google Scholar 

  12. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146–7.

    Article  CAS  PubMed  Google Scholar 

  13. Stellar S, Polanyi TG, Bredemeier HC. Experimental studies with the carbon dioxide laser as a neurosurgical instrument. Med Biol Eng. 1970;8(6):549–58.

    Article  CAS  PubMed  Google Scholar 

  14. Cerullo LJ, Mkrdichian EH. Acoustic nerve tumor surgery before and since the laser: comparison of results. Lasers Surg Med. 1987;7(3):224–8.

    Article  CAS  PubMed  Google Scholar 

  15. Ryan RW, Wolf T, Spetzler RF, Coons SW, Fink Y, Preul MC. Application of a flexible CO(2) laser fiber for neurosurgery: laser-tissue interactions. J Neurosurg. 2010;112(2):434–43.

    Article  PubMed  Google Scholar 

  16. Eiras J, Alberdi J, Gomez J. Laser CO2 in the surgery of acoustic neuroma. Neurochirurgie. 1993;39(1):16–21; discussion 21–3.

    CAS  PubMed  Google Scholar 

  17. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg. 1995;113(3):179–80.

    Google Scholar 

  18. Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol. 1988;97(1):55–66.

    Article  CAS  PubMed  Google Scholar 

  19. Ben Ammar M, Piccirillo E, Topsakal V, Taibah A, Sanna M. Surgical results and technical refinements in translabyrinthine excision of vestibular schwannomas: the Gruppo Otologico experience. Neurosurgery. 2012;70(6):1481–91; discussion 91.

    Article  PubMed  Google Scholar 

  20. Nonaka Y, Fukushima T, Watanabe K, Friedman AH, Sampson JH, Mcelveen JT, et al. Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery. 2013;72(2 Suppl Operative):ons103–15; discussion ons15.

    PubMed  Google Scholar 

  21. Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg. 2006;105(4):527–35.

    Article  PubMed  Google Scholar 

  22. Passacantilli E, Antonelli M, D’Amico A, Delfinis CP, Anichini G, Lenzi J, et al. Neurosurgical applications of the 2-μm thulium laser: histological evaluation of meningiomas in comparison to bipolar forceps and an ultrasonic aspirator. Photomed Laser Surg. 2012;30(5):286–92.

    Article  PubMed  Google Scholar 

  23. Wanibuchi M, Fukushima T, Friedman AH, Watanabe K, Akiyama Y, Mikami T, et al. Hearing preservation surgery for vestibular schwannomas via the retrosigmoid transmeatal approach: surgical tips. Neurosurg Rev. 2014;37(3):431–44; discussion 44.

    Article  PubMed  Google Scholar 

  24. Flamm ES, Ransohoff J, Wuchinich D, Broadwin A. Preliminary experience with ultrasonic aspiration in neurosurgery. Neurosurgery. 1978;2:240–5.

    Article  CAS  PubMed  Google Scholar 

  25. Sawamura Y, Fukushima T, Terasaka S, Sugai T. Development of a handpiece and probes for a microsurgical ultrasonic aspirator: instrumentation and application. Neurosurgery. 1999;45(5):1192–6; discussion 7.

    Article  CAS  PubMed  Google Scholar 

  26. Ridderheim PA, von Essen C, Zetterlund B. Indirect injury to cranial nerves after surgery with Cavitron ultrasonic surgical aspirator (CUSA). Case report. Acta Neurochir. 1987;89(1–2):84–6.

    Article  CAS  PubMed  Google Scholar 

  27. Epstein F. The Cavitron ultrasonic aspirator in tumor surgery. Clin Neurosurg. 1983;31:497–505.

    Article  CAS  PubMed  Google Scholar 

  28. Kanzaki J, Inoue Y, Kurashima K, Shiobara R. Use of the ultrasonically activated scalpel in acoustic neuroma surgery: preliminary report. Skull Base Surg. 2000;10(2):71–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Golub JS, Weber JD, Leach JL, Pottschmidt NR, Zuccarello M, Pensak ML, et al. Feasibility of the ultrasonic bone aspirator in retrosigmoid vestibular schwannoma removal. Otolaryngol Head Neck Surg. 2015;153(3):427–32.

    Article  PubMed  Google Scholar 

  30. Weber JD, Samy RN, Nahata A, Zuccarello M, Pensak ML, Golub JS. Reduction of bone dust with ultrasonic bone aspiration: implications for retrosigmoid vestibular schwannoma removal. Otolaryngol Head Neck Surg. 2015;152(6):1102–7.

    Article  PubMed  Google Scholar 

  31. Modest MC, Carlson ML, Link MJ, Driscoll CL. Ultrasonic bone aspirator (Sonopet) for meatal bone removal during retrosigmoid craniotomy for vestibular schwannoma. Laryngoscope. 2017;127(4):805–8.

    Article  PubMed  Google Scholar 

  32. Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus. 2012;33(3):E14.

    Article  PubMed  Google Scholar 

  33. Teo MK, Eljamel MS. Role of craniotomy repair in reducing postoperative headaches after a retrosigmoid approach. Neurosurgery. 2010;67(5):1286–91; discussion 91–2.

    Article  PubMed  Google Scholar 

  34. Ito T, Mochizuki H, Watanabe T, Kubota T, Furukawa T, Koike T, et al. Safety of ultrasonic bone curette in ear surgery by measuring skull bone vibrations. Otol Neurotol. 2014;35(4):e135–9.

    Article  PubMed  Google Scholar 

  35. Levo H, Pyykkö I, Blomstedt G. Postoperative headache after surgery for vestibular schwannoma. Ann Otol Rhinol Laryngol. 2000;109(9):853–8.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, San Filippo Neri Hospital—ASLRoma1, Rome, Italy

    Luciano Mastronardi, Alberto Campione, Raffaelino Roperto & Guglielmo Cacciotti

  2. Division of Neurosurgery, Duke University Medical Center, Carolina Neuroscience Institute, Raleigh, NC, USA

    Ali Zomorodi & Takanori Fukushima

Authors
  1. Luciano Mastronardi
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  2. Alberto Campione
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  3. Ali Zomorodi
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  4. Raffaelino Roperto
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  5. Guglielmo Cacciotti
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  6. Takanori Fukushima
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Corresponding author

Correspondence to Luciano Mastronardi .

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Editors and Affiliations

  1. Unit of Neurosurgery ASLRoma1, San Filippo Neri Hospital, Roma, Italy

    Luciano Mastronardi  & Alberto Campione  & 

  2. Neurosurgery Department, Duke Medical Center, Raleigh, NC, USA

    Takanori Fukushima

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Mastronardi, L., Campione, A., Zomorodi, A., Roperto, R., Cacciotti, G., Fukushima, T. (2019). Usefulness of Laser and Ultrasound Aspirator. In: Mastronardi, L., Fukushima, T., Campione, A. (eds) Advances in Vestibular Schwannoma Microneurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-03167-1_11

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  • DOI: https://doi.org/10.1007/978-3-030-03167-1_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03166-4

  • Online ISBN: 978-3-030-03167-1

  • eBook Packages: MedicineMedicine (R0)

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