Use of an ultrasonic aspirator in transnasal surgery of tumorous lesions of the anterior skull base

• Main Authors: Georg J. Ledderose, Niklas Thon, Walter Rachinger, Christian S. Betz
• Format: Article
• Language: English
• Published: Elsevier 2019-12-01
• Series: Interdisciplinary Neurosurgery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751919301173

Objective: Ultrasound aspirators are commonly used in open transcranial neurosurgery but are also applied in various other surgical settings. The specific properties of the instrument seem to make it particularly suitable for endoscopic transnasal skull base surgery. Reports about its use in this area, however, showed heterogeneous results. Methods: In this feasibility trial, advantages and disadvantages of using the Sonopet ultrasound aspirator (Stryker Corporation, Kalamazoo, MI, USA) for the ablation of hard as well as soft tissue was tested in conjunction with extra-long tips in a total of 10 patients who underwent transnasal surgery of various tumorous pathologies of the skull base. Results were evaluated qualitatively and with a standardized questionnaire. Results: The handling and operating of the ultrasound aspirator (UA) is intuitive and easy to learn. The design of the different tips is suitable to address pathologies of the anterior skull base back to the clivus. However, lesions far off the midline are difficult or even impossible to reach. The UA allows a precise and selective operation. Structures as the dura or large vessels are well respected. The participating surgeons felt that the benefits of using the UA outweighed the extra effort. Conclusions: The ultrasound aspirator (UA) seems well suited for an application in transnasal endoscopic skull base surgery. It serves as an useful supplement to cold steel instruments, burrs and microdebriders. Limitations of reach become especially apparent when it is used off the midline corridor. Significant additional cost might restrict the use of the UA to single, selected cases. Future large-scale trials will be needed to define in more detail which surgical conditions may benefit most from its use. Keywords: Transnasal skull base surgery, Ultrasonic aspirator, Endoscopic skull base surgery, Tumorous lesions of the skull base