Hadeishi Hiromu, Suzuki Akifumi, Yasui Nobuyuki, Satou Yuichirou
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
Neurosurgery. 2003 Apr;52(4):867-70; discussion 870-1. doi: 10.1227/01.neu.0000053147.67715.58.
During cranial base surgery, use of a high-speed drill for osteotomy has become common. We performed anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette, and we report the advantages and clinical applications of this method.
The ultrasonic surgical equipment comprises a power supply unit, footswitch, and handpiece (weight, 110 g; diameter, 20 mm; length, 140 mm from tip to angled section). The handpiece tip is 2 mm wide, and the amplitude of longitudinal vibration can be varied from 120 to 365 microm at an ultrasonic frequency of 25 kHz. Cool-controlled irrigation fluid emerges near the tip, through the sheath.
We performed anterior clinoidectomy in eight cases of paraclinoid aneurysm and opening of the internal auditory canal in six cases of acoustic neuroma without damage to the dura mater or nearby structures such as brain tissue, blood vessels, and cranial nerves. In addition, no damage to the facial nerve or labyrinthine organ resulted from heat or vibration caused by the ultrasonic bone curette.
Ultrasonic bone curettage represents safe instrumentation for performance of anterior clinoidectomy and opening of the internal auditory canal without damage to surrounding structures. This technique allows surgeons to perform procedures on deep areas without incurring psychomotor stress.
在颅底手术中，使用高速钻进行截骨术已很常见。我们使用超声骨刮匙进行前床突切除术和内耳道开放术，并报告该方法的优点及临床应用。
超声手术设备包括电源装置、脚踏开关和机头（重量110克；直径20毫米；从尖端到弯曲部分长度140毫米）。机头尖端宽2毫米，在25千赫的超声频率下，纵向振动幅度可在120至365微米之间变化。冷却控制的冲洗液通过护套在尖端附近流出。
我们对8例床突旁动脉瘤患者进行了前床突切除术，对6例听神经瘤患者进行了内耳道开放术，未损伤硬脑膜或脑组织、血管和颅神经等附近结构。此外，超声骨刮匙产生的热量或振动未导致面神经或迷路器官受损。
超声骨刮匙是进行前床突切除术和内耳道开放术且不损伤周围结构的安全器械。该技术使外科医生能够在深部区域进行手术而不会产生精神运动应激。
