Comunicazioni orali

Piezosurgical device for mini demolitive craniotomies in brain tumors surgery

I.G. Vetrano, M. Saini, F. Prada, F. Di Meco

Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Department of Neurosurgery, Milan, Italy, Johns Hopkins University, Department of Neurosurgery, Baltimore, United States

Background: Piezoelectric surgery represents an innovative surgical technique to perform a safe and effective osteotomy or osteoplasty that contrasts with the traditional bony tissue management methods using rotating or perforating instruments, with bone tissue loss and possibility of vascular and soft tissue injury.

Objective: To evaluate safety and feasibility of craniotomies using an ultrasonic scalpel that allow a selective cut of only mineralized structures avoiding damages to the vascular, dural and parenchymal structures.

Methods: A case series of 300 patients undergoing elective cranial surgery from 2013 to 2016, in which craniotomy was achieved by using a piezoelectric device, was retrospectively reviewed.

Results: Supratentorial craniotomy was performed in 196 patients, the remaining 104 underwent subtentorial ones. Mean patient age was 53.3 years (ranging from 01 to 81). Among them, 53 patients were affected by vestibular schwannomas, 129 by meningiomas. 69 were gliomas and 12 metastasys, with other histological subtypes amounting for 37. The device was used to gain access to the skull base, to fashion a parasagittal craniotomy over underlying dural sinuses and, in 26 cases of vestibular schwannoma surgery, to open the internal acoustic meate. In our series, including procedures performed on elderly patients, no parenchymal tissue damage or injuries to dural veins were reported. We observed minor dural tear in 21 cases (0,07%), which required surgical sutures.

Conclusion: We illustrate an alternative technique to perform craniotomy for brain tumor surgery whichemploys an ultrasonic bone dissector to safely achieve bone removal. This surgical technique appears to be safe and complication free with excellent cosmetic results.

Oral communication held during the EANS2017 Congress (European Association of Neurosurgical Societies) - October 1st - 5th 2017 - Venice Convention - Lungomare Guglielmo Marconi 30, 30126 Venice, Italy