Tissue dissection before direct manipulation to the pathology with pulsed laser-induced liquid jet system in skull base surgery - Preservation of fine vessels and maintained optic nerve function

Yoshikazu Ogawa, Atsuhiro Nakagawa, Toshikatsu Washio, Tatsuhiko Arafune, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)

Abstract

Background: Most difficulties in skull base tumor removal are generally caused by adhesion of feeding arteries to the vital structures and cranial nerves. Water jet technology provides tissue dissectability with preservation of fine blood vessels both in experimental and clinical situations. However problems still remain regarding whether tumor removal with preservation of peripheral nerve function is possible or not. This clinical investigation evaluated functional preservation of peripheral nerves and dissectability with a newly developed pulsed laser-induced liquid jet (LILJ) system under intraoperative electrophysiological monitoring. Methods: The LILJ system was used to treat 21 patients with skull base tumors manifesting as severe visual disturbance through the extended transsphenoidal approach. The LILJ system consists of a bayonet-shaped catheter incorporating a jet generator, and total weight is around 7 g. Intraoperative visual evoked potential (VEP), and pre/postoperative conventional visual assessments were investigated. Results: Precise dissections of the tumor were obtained, resulting in gross total removal in 19 of 21 patients. Two patients with meningiomas with tight adhesion to the origin of the lenticulostriate arteries had small remnants. Of the 21 patients, 16 showed immediate improvement on intraoperative VEP, 2 had no change, and 3 had prolonged latency, which required intermittent suspension of procedure. A total of 20 patients and 40 eyes showed good recovery at discharge, and all patients evaluated had recovered good visual status. Conclusions: The LILJ system can achieve safe and optimal removal with functional preservation of optic nerves, probably because of the high resistance of the arachnoidal sheath and fine vascular tissue.

Original languageEnglish
Pages (from-to)1879-1886
Number of pages8
JournalActa neurochirurgica
Volume155
Issue number10
DOIs
Publication statusPublished - 2013 Oct

Keywords

  • Cranial nerve
  • Functional preservation
  • Ho:YAG laser
  • Skull base tumor
  • Vascular preservation
  • Water jet

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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