Application of Ultrasonic Bone Curette in Endoscopic Endonasal Skull Base Surgery: Technical Note

Abstract

Background Endoscopic endonasal surgery (EES) of the skull base often requires extensive bone work in proximity to critical neurovascular structures.

Objective To demonstrate the application of an ultrasonic bone curette during EES.

Methods Ten patients with skull base lesions underwent EES from September 2011 to April 2012 at the University of Pittsburgh Medical Center. Most of the bone work was done with high-speed drill and rongeurs. The ultrasonic curette was used to remove specific structures.

Results All the patients were submitted to fully endoscopic endonasal procedures and had critical bony structures removed with the ultrasonic bone curette. Two patients with degenerative spine diseases underwent odontoid process removal. Five patients with clival and petroclival tumors underwent posterior clinoid removal. Two patients with anterior fossa tumors underwent crista galli removal. One patient underwent unilateral optic nerve decompression. No mechanical or heat injury resulted from the ultrasonic curette. The surrounding neurovascular structures and soft tissue were preserved in all cases.

Conclusion In selected EES, the ultrasonic bone curette was successfully used to remove loose pieces of bone in narrow corridors, adjacent to neurovascular structures, and it has advantages to high-speed drills in these specific situations.

Keywords

endoscopic endonasal - skull base - bone removal - ultrasonic bone curette

• References

• 1 Maroon JC. Skull base surgery: past, present, and future trends. Neurosurg Focus 2005; 19 (1) E1
• 2 Prevedello DM, Doglietto F, Jane Jr JA, Jagannathan J, Han J, Laws Jr ER. History of endoscopic skull base surgery: its evolution and current reality. J Neurosurg 2007; 107 (1) 206-213
• 3 Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB. What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base. Keio J Med 2009; 58 (3) 152-160
• 4 Yamasaki T, Moritake K, Nagai H, Uemura T, Shingu T, Matsumoto Y. A new, miniature ultrasonic surgical aspirator with a handpiece designed for transsphenoidal surgery. Technical note. J Neurosurg 2003; 99 (1) 177-179
• 5 Pagella F, Giourgos G, Matti E, Colombo A, Carena P. Removal of a fronto-ethmoidal osteoma using the Sonopet omni ultrasonic bone curette: first impressions. Laryngoscope 2008; 118 (2) 307-309
• 6 Bruggers S, Sindwani R. Evolving trends in powered endoscopic sinus surgery. Otolaryngol Clin North Am 2009; 42 (5) 789-798 , viii
• 7 Cappabianca P, Cavallo LM, Esposito I, Barakat M, Esposito F. Bone removal with a new ultrasonic bone curette during endoscopic endonasal approach to the sellar-suprasellar area: technical note. Neurosurgery 2010; 66 (3, Suppl Operative): E118 ; discussion E118
• 8 Hadeishi H, Suzuki A, Yasui N, Satou Y. Anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette. Neurosurgery 2003; 52 (4) 867-870 ; discussion 870–871
• 9 Sawamura Y, Fukushima T, Terasaka S, Sugai T. Development of a handpiece and probes for a microsurgical ultrasonic aspirator: instrumentation and application. Neurosurgery 1999; 45 (5) 1192-1196 ; discussion 1197
• 10 Chang HS, Joko M, Song JS, Ito K, Inoue T, Nakagawa H. Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy. Technical note. J Neurosurg 2006; 104 (4) 621-624
• 11 Kim K, Isu T, Morimoto D, Kominami S, Kobayashi S, Teramoto A. Anterior vertebral artery decompression with an ultrasonic bone curette to treat bow hunter's syndrome. Acta Neurochir (Wien) 2008; 150 (3) 301-303 ; discussion 303
• 12 Nakase H, Matsuda R, Shin Y, Park YS, Sakaki T. The use of ultrasonic bone curettes in spinal surgery. Acta Neurochir (Wien) 2006; 148 (2) 207-212 ; discussion 212–213
• 13 Nakagawa H, Kim SD, Mizuno J, Ohara Y, Ito K. Technical advantages of an ultrasonic bone curette in spinal surgery. J Neurosurg Spine 2005; 2 (4) 431-435
• 14 Kim K, Isu T, Matsumoto R, Isobe M, Kogure K. Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Neurosurgery 2006; 59 (4) (Suppl. 02) ONS390-ONS393 ; discussion ONS393
• 15 Ito K, Ishizaka S, Sasaki T , et al. Safe and minimally invasive laminoplastic laminotomy using an ultrasonic bone curette for spinal surgery: technical note. Surg Neurol 2009; 72 (5) 470-475 ; discussion 475
• 16 de Divitiis E, Cappabianca P, Cavallo LM. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 2002; 51 (3) 699-705 ; discussion 705–707
• 17 Cappabianca P, Cavallo LM, de Divitiis E. Endoscopic endonasal transsphenoidal surgery. Neurosurgery 2004; 55 (4) 933-940 ; discussion 940–941
• 18 Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 2005; 57 (1, Suppl): E213 ; discussion E213
• 19 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
• 20 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
• 21 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
• 22 Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 2007; 106 (3) 400-406
• 23 Gardner PA, Kassam AB, Thomas A , et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63 (1) 36-52 ; discussion 52–54