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J Neurol Surg A Cent Eur Neurosurg 2015; 76(06): 473-482
DOI: 10.1055/s-0034-1396436
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pulsed Laser-induced Liquid Jet System for Treatment of Sellar and Parasellar Tumors: Safety Evaluation

Atsuhiro Nakagawa
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
Yoshikazu Ogawa
2   Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
,
Kosaku Amano
3   Department of Neurosurgery, Tokyo Woman's Medical University, Tokyo, Japan
,
Yudo Ishii
4   Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
,
Shigeshi Tahara
4   Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
,
Kentaro Horiguchi
5   Department of Neurosurgery, Chiba University, Chiba, Japan
,
Takakazu Kawamata
3   Department of Neurosurgery, Tokyo Woman's Medical University, Tokyo, Japan
,
Shigetoshi Yano
6   Department of Neurosurgery, Kumamoto University Graduate School, Kumamoto, Japan
,
Tatsuhiko Arafune
7   Department of Bioengineering, The University of Tokyo, Tokyo, Japan
,
Toshikatsu Washio
8   Human Technology Research Institute, National Institutes for Advanced Industrial and Scientific Technology, Tsukuba, Japan
,
Jun-ichi Kuratsu
9   Department of Neurosurgery, Faculty of Life Sciences Research, Kumamoto University Graduate School, Kumamoto, Japan
,
Naokatsu Saeki
5   Department of Neurosurgery, Chiba University, Chiba, Japan
,
Yoshikazu Okada
3   Department of Neurosurgery, Tokyo Woman's Medical University, Tokyo, Japan
,
Akira Teramoto
4   Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
,
Teiji Tominaga
1   Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
› Author Affiliations
Further Information

Publication History

02 January 2014

15 September 2014

Publication Date:
16 January 2015 (online)

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Abstract

Objective The pulsed laser-induced liquid jet (LILJ) system is an emerging surgical instrument intended to assist both maximal removal of the lesion and functional maintenance through preservation of fine vessels and minimal damage to the surrounding tissue. The system ejects the minimum required amount of pulsed water through a handy bayonet-shaped catheter. We have already shown a significant increase in removal rate, in addition to a noteworthy reduction of intraoperative blood loss and procedure time in the treatment of large pituitary and skull base tumors in a single-institution series. The present study evaluated the safety of the system in multiple institutions.

Methods The study included 46 patients, 29 men and 17 women (mean age: 59.1 years) who underwent microsurgical/endoscopic resection of lesions in or in the vicinity of the pituitary fossa through the transsphenoidal approach between October 2011 and June 2012 at six institutions. The histologic diagnoses were pituitary adenoma (31 cases), meningioma (4), craniopharyngioma (3), cavernous angioma (2), and Rathke cyst cleft (1). Lesion volume ranged from 2.0 to 30.4 cm3 (mean: 3.7 cm3). Cavernous sinus invasion was observed in 11 cases and suprasellar extension in 29 cases.

Results Preservation of intralesional arteries (diameter: 150 µm) was achieved in all situations in > 80% of cases. Intended surgical steps were achieved except for some restrictions in motion due to the use of an optical quartz fiber. No complications occurred directly related to the use of the device.

Conclusions The LILJ system can be used for safe removal of lesions in or in the vicinity of the pituitary fossa.

Keywords

functional preservation - maximal lesion removal - minimally invasive surgery - medical engineering - water jet
 

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