Vetrano Ignazio G, Prada Francesco, Perin Alessandro, Casali Cecilia, DiMeco Francesco, Saini Marco
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA.
World Neurosurg. 2019 Feb;122:e1398-e1404. doi: 10.1016/j.wneu.2018.11.064. Epub 2018 Nov 17.
Piezoelectric surgery represents an innovative technique to perform safe and effective osteotomies and is an alternative to traditional bony tissue management using rotating or perforating instruments. We evaluated the safety and feasibility of craniotomies using an ultrasonic device that allows the selective cut of mineralized structures, avoiding damages to the vascular, dural, and parenchymal structures.
We analyzed a series of 300 patients (age range, 1-81 years; SD ± 15.2) who underwent elective cranial surgery for brain tumors, in which the craniotomy was performed using a piezoelectric device. Pre- and postoperative imaging, clinical notes, and intraoperative details were collected.
There were 197 patients (66%) who underwent surgery for supratentorial tumors; the remaining 103 patients (34%) underwent surgery for infratentorial ones. Tumors involved the skull base in 125 cases. Meningiomas, gliomas, and schwannomas represented the most common histotypes. Duraplasty for dural damages was not necessary in all cases; no venous sinuses or parenchymal injuries were reported during bone work. We noted in 13 cases (4.3%) a minor dural tear, requiring only direct sutures. Bone flaps were always intact after craniotomy. No subgaleal cerebrospinal fluid (CSF) collection or CSF leak was recorded. Because of the minimal bone gap, we always achieved correct bone flap ossification. No reabsorption or mobilization of bone flap was noted.
We illustrate the feasibility and safety of a piezosurgical cutter to perform craniotomies. This alternative technique appears to be safe, with excellent cosmetic effects, adding another tool to the neurosurgical armamentarium.
压电手术是一种进行安全有效截骨术的创新技术，是使用旋转或穿孔器械进行传统骨组织处理的替代方法。我们评估了使用一种能选择性切割矿化结构、避免损伤血管、硬脑膜和实质结构的超声设备进行开颅手术的安全性和可行性。
我们分析了300例（年龄范围1 - 81岁；标准差±15.2）因脑肿瘤接受择期开颅手术的患者，这些开颅手术使用了压电设备。收集了术前和术后的影像学资料、临床记录以及术中细节。
197例（66%）患者接受幕上肿瘤手术；其余103例（34%）接受幕下肿瘤手术。125例肿瘤累及颅底。脑膜瘤、胶质瘤和神经鞘瘤是最常见的组织学类型。并非所有病例都需要因硬脑膜损伤进行硬脑膜成形术；在骨操作过程中未报告静脉窦或实质损伤。我们注意到13例（4.3%）有轻微硬脑膜撕裂，仅需直接缝合。开颅术后骨瓣始终完整。未记录到帽状腱膜下脑脊液（CSF）积聚或CSF漏。由于骨间隙极小，我们总能实现骨瓣的正确骨化。未观察到骨瓣的再吸收或移位。
我们阐述了压电手术切割器进行开颅手术的可行性和安全性。这种替代技术似乎是安全的，具有出色的美容效果，为神经外科手术增添了另一种工具。
