Chin D, Snidvongs K, Sacks R, Harvey R J
Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia.
J Laryngol Otol. 2013 Jul;127 Suppl 2:S29-32. doi: 10.1017/S0022215113000510. Epub 2013 Apr 10.
Effective tissue removal techniques are essential in endoscopic skull base surgery. Improvements in technology permit more accurate application of CO2 laser and coblation during endonasal procedures. This study assessed the thermal injury patterns associated with fibre CO2 laser and coblation.
Fresh frozen cadaveric heads were used. Mucosal removal was performed at the ethmoid roof. Structured lesions were created using either CO2 laser or coblation. The corresponding thermal injury patterns on dural tissue were assessed and compared between the two groups.
Five cadaveric heads were obtained; five sides received CO2 laser lesions and five coblation lesions. Forty per cent (n = two sides) of the CO2 specimens had macroscopic foci of grey-black discolouration on the dural aspect. No macroscopic dural changes were seen in the coblation specimens.
Dural injury was seen following CO2 laser use despite attempts to avoid it. Both CO2 laser and coblation have their advantages; however, the lower thermal working power of coblation and superior depth control may make it more suitable for endoscopic endonasal periorbital and peridural surgery.
有效的组织切除技术在内镜颅底手术中至关重要。技术的进步使得在鼻内手术期间能够更精确地应用二氧化碳激光和低温等离子消融术。本研究评估了与光纤二氧化碳激光和低温等离子消融术相关的热损伤模式。
使用新鲜冷冻的尸体头部。在筛窦顶部进行黏膜切除。使用二氧化碳激光或低温等离子消融术制造结构性病变。评估并比较两组硬脑膜组织上相应的热损伤模式。
获取了五个尸体头部；五个侧面接受了二氧化碳激光损伤，五个侧面接受了低温等离子消融损伤。40%（n = 两个侧面）的二氧化碳激光标本在硬脑膜表面有肉眼可见的灰黑色变色病灶。低温等离子消融标本中未见肉眼可见的硬脑膜变化。
尽管试图避免，但使用二氧化碳激光后仍出现了硬脑膜损伤。二氧化碳激光和低温等离子消融术都有其优点；然而，低温等离子消融术较低的热工作功率和更好的深度控制可能使其更适合内镜鼻内眶周和硬膜外手术。
