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J Neurol Surg B Skull Base 2012; 73(01): 11-20
DOI: 10.1055/s-0032-1304834
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Side-Cutting Aspiration Device for Endoscopic and Microscopic Tumor Removal[*]

Nancy McLaughlin
1   Neuroscience Institute and Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
,
Leo F.S. Ditzel Filho
2   Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio
,
Daniel M. Prevedello
2   Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio
,
Daniel F. Kelly
1   Neuroscience Institute and Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
,
Ricardo L. Carrau
1   Neuroscience Institute and Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
3   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Medical Center, Columbus, Ohio
,
Amin B. Kassam
1   Neuroscience Institute and Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
› Author Affiliations
Further Information

Publication History

24 April 2011

12 July 2011

Publication Date:
24 February 2012 (online)

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Side-Cutting Aspiration Device for Endoscopic and Microscopic Tumor RemovalSkull Base 2011; 21(S 02): e2-e2
DOI: 10.1055/s-0031-1287679

Abstract

The authors present a unique side-cutting instrument (NICO Myriad, Indianapolis, IN) with variable aspiration designed specifically for tumor resection. The study included retrospective review of data collected from 10/2009 to 01/2011. We detail the use of the Myriad in 31 patients with the following pathologies: meningioma (n=16), chordoma (n = 3), schwannoma (n = 3), pituitary adenoma (n = 2), metastasis (n = 3), hemangioblastoma (n = 1), craniopharyngioma (n = 1), and nasopharyngeal tumors (n = 2). Surgical approaches included expanded endonasal approach (n = 19), endoscopic brain port (n = 3), supraorbital “eyebrow” craniotomy (n = 3), retrosigmoid suboccipital craniotomy (n = 3), pterional craniotomy (n = 1), extreme far lateral (n = 1), and laminectomy (n = 1). Successful tumor resection was achieved in 30 cases. Instrument failure was noted in only one extremely fibrous meningioma. The design of this instrument facilitated maneuvering through narrow corridors while providing direct visualization of the suction aperture during tumor resection. These features allowed for tumor removal without injury to adjacent neurovascular structures. The side-cutting aspiration device allows safe and effective tumor removal. Its low profile, variable aspiration, and lack of thermal heat energy are particularly useful in tumor resection through narrow corridors, such as endonasal, port, and keyhole approaches. The multifunctional nature of the instrument (suction, scissors, and dissectors) minimizes multiple exchanges, facilitating tumor resection through these minimal access corridors.

Keywords

brain tumor - skull base - instrumentation - endoscopy - microsurgery

* This article was originally Published online in Skull Base on September 16, 2011 (DOI:10.1055/s-0031-1287679)


 

  • References

  • 1 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 2005; 57 (4, Suppl) 242-255 ; discussion 242–255
    Google Scholar
  • 2 Perneczky A, Fries G. Endoscope-assisted brain surgery: part 1—evolution, basic concept, and current technique. Neurosurgery 1998; 42 (2) 219-224 ; discussion 224–225
    CrossrefPubMedGoogle Scholar
  • 3 Fatemi N, Dusick JR, de Paiva Neto MA, Malkasian D, Kelly DF. Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Neurosurgery 2009; 64 (5, Suppl 2) 269-284 ; discussion 284–286
    Google Scholar
  • 4 Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 2005; 19 (1) E3
    PubMedGoogle Scholar
  • 5 Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 2005; 19 (1) E4
    CrossrefPubMedGoogle Scholar
  • 6 Kassam AB, Prevedello DM, Carrau RL , et al. The front door to Meckel's cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 2009; 64 (3, Suppl) 71-82 ; discussion 82–83
    PubMedGoogle Scholar
  • 7 Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19 (1) E6
    PubMedGoogle Scholar
  • 8 Harris AE, Hadjipanayis CG, Lunsford LD, Lunsford AK, Kassam AB. Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery 2005; 56 (1, Suppl) 125-132 ; discussion 125–132
    PubMedGoogle Scholar
  • 9 Engh JA, Lunsford LD, Amin DV , et al. Stereotactically guided endoscopic port surgery for intraventricular tumor and colloid cyst resection. Neurosurgery 2010; 67 (3, Suppl Operative) ons198-ons204 ; discussion ons204–ons205
    CrossrefPubMedGoogle Scholar
  • 10 Kassam AB, Engh JA, Mintz AH, Prevedello DM. Completely endoscopic resection of intraparenchymal brain tumors. J Neurosurg 2009; 110 (1) 116-123
    CrossrefPubMedGoogle Scholar
  • 11 Cappabianca P, Alfieri A, Thermes S, Buonamassa S, de Divitiis E. Instruments for endoscopic endonasal transsphenoidal surgery. Neurosurgery 1999; 45 (2) 392-395 ; discussion 395–396
    CrossrefPubMedGoogle Scholar
  • 12 Rhoton Jr AL. Operative techniques and instrumentation for neurosurgery. Neurosurgery 2003; 53 (4) 907-934 ; discussion 934
    CrossrefPubMedGoogle Scholar
  • 13 Fernandez-Miranda JC, Engh JA, Pathak SK , et al. High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery. J Neurosurg 2010; 113 (5) 990-999
    CrossrefPubMedGoogle Scholar
  • 14 Inoue T, Ikezaki K, Sato Y. Ultrasonic surgical system (SONOPET) for microsurgical removal of brain tumors. Neurol Res 2000; 22 (5) 490-494
    CrossrefPubMedGoogle Scholar
  • 15 Cimino WW, Bond LJ. Physics of ultrasonic surgery using tissue fragmentation: part I. Ultrasound Med Biol 1996; 22 (1) 89-100
    CrossrefPubMedGoogle Scholar
  • 16 Bond LJ, Cimino WW. Physics of ultrasonic surgery using tissue fragmentation: part II. Ultrasound Med Biol 1996; 22 (1) 101-117
    CrossrefPubMedGoogle Scholar
  • 17 Levy ML, McComb JG. Integration of a variable action suction adapter into ultrasonic aspirators. Neurosurgery 1999; 45 (4) 893-895
    PubMedGoogle Scholar
  • 18 Blackie RA, Gordon A. Histological appearances of intracranial biopsies obtained using the Cavitron ultrasonic surgical aspirator. J Clin Pathol 1984; 37 (10) 1101-1104
    CrossrefPubMedGoogle Scholar
  • 19 Brock M, Ingwersen I, Roggendorf W. Ultrasonic aspiration in neurosurgery. Neurosurg Rev 1984; 7 (2-3) 173-177
    CrossrefPubMedGoogle Scholar
  • 20 Bagley RS, Harrington ML, Gay JM, Silver GM. Effects of changes in power setting of an ultrasonic aspirator on amount of damage to the cerebral cortex of healthy dogs. Am J Vet Res 2001; 62 (2) 248-251
    CrossrefPubMedGoogle Scholar
  • 21 Gleeson MJ, Fisch U, Felix H. A morphological study of the effect of the Cavitron ultrasonic surgical aspirator system near human peripheral nerves. Arch Otolaryngol Head Neck Surg 1987; 113 (5) 530-532
    CrossrefPubMedGoogle Scholar
  • 22 Gleeson MJ, Felix H. The cavitron ultrasonic surgical aspirator system. An anatomical and physiological study of the effect of its use on the rat facial nerve. Clin Otolaryngol Allied Sci 1986; 11 (3) 177-187
    PubMedGoogle Scholar
  • 23 Preston JK, Masciopinto J, Salamat MS, Badie B. Tumour cell dispersion by the ultrasonic aspirator during brain tumor resection. Br J Neurosurg 1999; 13 (5) 486-489
    PubMedGoogle Scholar
  • 24 Lekovic GP, Gonzalez LF, Feiz-Erfan I, Rekate HL. Endoscopic resection of hypothalamic hamartoma using a novel variable aspiration tissue resector. Neurosurgery 2006; 58 (1, Suppl) ONS166-ONS169 ; discussion ONS166–ONS169
    PubMedGoogle Scholar
  • 25 Dlouhy BJDN, Dahdaleh NS, Greenlee JD. Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad. Neurosurg Focus 2011; 30 (4) E6
    PubMedGoogle Scholar
  • 26 Garcia-Navarro VLG, Lancman G, Guerrero-Maldonado A, Anand VK, Schwartz TH. Use of a side-cutting aspiration device for resection of tumors during endoscopic endonasal approaches. Neurosurg Focus 2011; 30 (4) E13
    PubMedGoogle Scholar