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Use of BoneScalpel Ultrasonic Bone Dissector in Anterior Clinoidectomy and Posterior Fossa Surgery: Technical Note

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The Funnel: From the Skull Base to the Sacrum

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 135))

Abstract

Background

First popularized by Dolenc, anterior clinoidectomies were performed with rongeurs, before the adoption of modern high-speed drills. We describe a novel application of the piezoelectric BoneScalpel™ in anterior skull base and posterior fossa surgeries. In the literature, to date, there are no mentions of anterior clinoidectomies performed with piezosurgical devices.

Methods

We reported a total of 12 patients, 8 affected by posterior fossa tumors and 4 treated for anterior skull base oncologic and vascular pathologies. This study aims to assess the safety and efficacy of the piezoelectric osteotomy in skull base and posterior fossa surgeries. In all patients, an ultrasonic bone dissector (BoneScalpel™ – Misonix) was used to perform the anterior clinoidectomy (AC) and craniotomy.

Results

A successful clinoidectomy was performed in 4 out of 12 patients (33.3%). We did not notice any heat damage to the surrounding soft tissue in critical areas such as paraclinoid structures. We documented only one durotomy in an oncologic patient, while no lesions of SSS or TS were detected.

We recorded only a slightly increased surgery duration in the PIEZOSURGERY® and BoneScalpel™ group, compared to standard surgery with an osteotome to perform craniotomies, but no time difference in performing the clinoidectomy between BoneScalpel™ and a conventional high-speed drill.

Conclusion

We report the first experience with piezosurgery for anterior clinoidectomy. There is no time difference in performing the clinoidectomy between BoneScalpel™ and a conventional high-speed drill, and this is an undoubted advantage in critical contexts such as clinoid-paraclinoid surgeries, where the risk of dural sinuses tears is common.

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Acknowledgements

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

There are no conflicts of interest.

Patient Consent

Patient’s consent not required as patient’s identity is not disclosed or compromised.

Ethics Approval

There is no ethical issue in this paper. The described technique does not present important variations from the classical one and does not involve additional risks for the patient.

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Authors and Affiliations

  1. Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy

    Giuseppe Emmanuele Umana, Salvatore Cicero, Angelo Spitaleri & Marco Fricia

  2. Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, Catania, Italy

    Gianluca Scalia & Giovanni Federico Nicoletti

  3. Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria

    Santino Ottavio Tomasi

  4. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

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  1. Giuseppe Emmanuele Umana
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  1. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

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Umana, G.E. et al. (2023). Use of BoneScalpel Ultrasonic Bone Dissector in Anterior Clinoidectomy and Posterior Fossa Surgery: Technical Note. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_22

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  • DOI: https://doi.org/10.1007/978-3-031-36084-8_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-36083-1

  • Online ISBN: 978-3-031-36084-8

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