Strijbos Ruben M, Straatman Louise V, Stokroos Robert J, Johansson Martin L
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands.
Front Surg. 2022 Mar 21;9:858117. doi: 10.3389/fsurg.2022.858117. eCollection 2022.
The procedure for installation of a percutaneous bone-conducting device has undergone significant improvements since its introduction 40 years ago. Today, the linear incision technique with tissue preservation (LITT-P) and the minimally invasive procedure (MIPS) are the most commonly used approaches. In both these techniques, a gradual increase of the osteotomy using a three-step drilling sequence is utilized, as this approach can allow a stepwise deepening and widening of the osteotomy in the mastoid and can prevent bone overheating. A new minimally invasive procedure (MONO) has been developed that allows an osteotomy to be performed and enables complete removal of the bone volume in one single drill step for a 4 mm implant using a novel parabolic twist drill. Here, the feasibility of the MONO procedure was qualitatively and quantitatively evaluated in terms of the dura response to drill trauma in comparison with the outcomes achieved with guide drills used for the LITT-P and MIPS techniques. Fresh frozen temporal bone from a human cadaver was subjected to penetration by three drills beyond the base of the mastoid bone to different depths. The sites were evaluated, and the damage to and possible penetration of the dura were determined. The results showed that for a drill depth exceeding mastoid bone thickness by not more than 1 mm, damage to the dura was limited or nonexistent, whereas for a drill depth exceeding bone thickness by 2 mm, damage increased, or the dura was penetrated. There was a trend toward more damage and penetration for both the round burr and MIPS guide drill compared with the MONO drill bit. From this experimental study, it can be concluded that if the dura is encountered, the MONO system is not more inclined to penetrate the dura than the conventional LITT-P and MIPS systems.
自40年前经皮骨传导装置引入以来，其安装程序已取得显著改进。如今，保留组织的线性切口技术（LITT-P）和微创手术（MIPS）是最常用的方法。在这两种技术中，均采用三步钻孔序列逐步增加截骨量，因为这种方法可以使乳突截骨逐步加深和加宽，并能防止骨过热。现已开发出一种新的微创手术（MONO），该手术允许进行截骨，并能使用新型抛物线麻花钻在一个单一钻孔步骤中为4毫米植入物完全去除骨量。在此，与用于LITT-P和MIPS技术的导向钻所取得的结果相比，从硬脑膜对钻孔创伤的反应方面对MONO手术的可行性进行了定性和定量评估。取自人类尸体的新鲜冷冻颞骨被三根钻头穿透乳突骨基部至不同深度。对这些部位进行评估，并确定硬脑膜的损伤情况和可能的穿透情况。结果表明，当钻孔深度超过乳突骨厚度不超过1毫米时，硬脑膜损伤有限或不存在，而当钻孔深度超过骨厚度2毫米时，损伤增加或硬脑膜被穿透。与MONO钻头相比，圆头锉和MIPS导向钻均有更多损伤和穿透的趋势。从这项实验研究可以得出结论，如果遇到硬脑膜，MONO系统并不比传统的LITT-P和MIPS系统更倾向于穿透硬脑膜。
