Abstracts scientifici

Gli abstracts più recenti sulla tecnologia PIEZOSURGERY®

Piezosurgery for infra- and supratentorial craniotomies in brain tumors surgery.

Vetrano IG, Prada F, Perin A, Casali C, DiMeco F, Saini M.

World Neurosurg. 2018 Nov 17. pii: S1878-8750(18)32611-1. doi: 10.1016/j.wneu.2018.11.064. [Epub ahead of print]

Abstract

OBJECTIVE: Piezoelectric surgery represents an innovative technique to perform safe and effective osteotomies, alternative to traditional bony tissue management using rotating or perforating instruments. We evaluated 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.

METHODS: We analyzed a series of 300 patients (range 1-81 years, SD±15.2) that underwent elective cranial surgery for brain tumors, in which the craniotomy was performed using a piezoelectric device. Preoperative and postoperative imaging, clinical notes and intraoperative details were collected.

RESULTS: 197 patients (66%) underwent surgery for supratentorial tumors, the remaining 103 (34%) 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 were recorded. Due to the minimal bone gap, we always achieved correct bone flaps ossification. No reabsorption or mobilization of bone flap was noted.

CONCLUSION: 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.

Copyright © 2018 Elsevier Inc. All rights reserved.

KEYWORDS: Brain tumors; Craniotomy; Dural sinuses; Piezosurgery; Ultrasonic surgery.

Piezoelectric Surgery for Dorsal Spine: A technical note.

Franzini, Legnani, Beretta, Prada, DiMeco, Visintini, Franzini.

World Neurosurg. 2018 Mar 9. pii: S1878-8750(18)30496-0. doi: 10.1016/j.wneu.2018.03.026. [Epub ahead of print]

Abstract

BACKGROUND: Laminoplasty and laminectomy are two common surgical procedures utilized in approaching degenerative and neoplastic disease of the spinal canal. Routinely adopted instruments, such as Kerrison rongeur or high-speed drill (HSD), entail some potentially serious complications such as dura injuring and thermal and mechanical damage to neurovascular structures. We have adopted piezoelectric bone surgery, which permits a selective cut of mineralized tissues, to perform posterior procedures on the thoracic spine, where the relationship between bone and the spinal cord are critical.

OBJECTIVE: To evaluate the use of piezoelectric surgery for performing dorsal spine laminectomy and laminoplasty.

METHODS: Mectron piezosurgery device is an instrument developed for cutting bone with microvibrations that are created by the piezoelectric effect. This instrument allows a safe and precise bone cut, and it is characterized by no heat generation, thus avoiding thermal injury to bone and soft tissues. We have adopted this device to perform eight laminoplasty for tumors of the dorsal spine and two laminectomies for thoracic spinal stenosis, for a total of ten patients.

RESULTS: Across all surgeries there were no procedure-related intraoperative complications, such as dura injuring or damage to neural structures.CONCLUSION:The piezoelectric device showed excellent results in terms of safety and precise bone cutting properties when performing posterior surgical procedures in the dorsal spine, where thermal injury produced by the conventionally used drill may damage the spinal cord, closer to bony elements.

KEYWORDS: Dorsal spine; Laminectomy; Laminoplasty; Mectron; Piezoelectric surgery; Thoracic spinal stenosis

Copyright © 2018 Elsevier Inc. All rights reserved.

Structural and ultrastructural analyses of bone regeneration in rabbit cranial osteotomy: Piezosurgery versus traditional osteotomes.

Anesi A, Ferretti M, Cavani F, Salvatori R, Bianchi M, Russo A, Chiarini L, Palumbo C.

J Craniomaxillofac Surg. 2017 Oct 12. pii: S1010-5182(17)30343-8. doi: 10.1016/j.jcms.2017.10.004. [Epub ahead of print]

Abstract

Clinical advantages of piezosurgery have been already proved. However, few investigations have focused on the dynamics of bone healing. The aim of this study was to evaluate, in adult rabbits, bone regeneration after cranial linear osteotomies with two piezoelectrical devices (Piezosurgery® Medical - PM and Piezosurgery® Plus - PP), comparing them with conventional rotary osteotomes (RO). PP was characterized by an output power three times higher than PM. Fifteen days after surgery, histomorphometric analyses showed that the osteotomy gap produced with PM and PP was about half the size of that produced by RO, and in a more advanced stage of recovery. Values of regenerated bone area with respect to the total osteotomy area were about double in PM and PP samples compared with RO ones, while the number of TRAP-positive (tartrate-resistant acid phosphatase positive) osteoclasts per linear surface showed a significant increase, suggesting greater bone remodelling. Under scanning electron microscopy, regenerated bone displayed higher cell density and less mineralized matrix compared with pre-existent bone for all devices used. Nanoindentation tests showed no changes in elastic modulus. In conclusion, PM/PP osteotomies can be considered equivalent to each other, and result in more rapid healing compared with those using RO.

KEYWORDS: Bone regeneration; Cranial osteotomy; Elastic modulus; Nanoindentation; Piezosurgery