gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Piezosurgical bone removal: laboratory evaluation and report of experience in decompressive surgery of the optic nerve

Piezochirurgische knöcherne Dekompression: Experimentelle Evaluierung und Erfahrungsbericht bei knöcherner Dekompression des Nervus Opticus

Meeting Abstract

  • corresponding author M.R. Kotter - Universitätsklinik für Neurochirurgie, Medizinische Universität Wien
  • G. Widhalm - Universitätsklinik für Neurochirurgie, Medizinische Universität Wien
  • R. Vig - Universitätsklinik für Neurochirurgie, Medizinische Universität Wien
  • H. Widhalm - Universitätsklinik für Unfallchirurgie, Medizinische Universität Wien
  • R. J. M. Franklin - Cambridge Centre for Brain Repair, Dept Clin Vet Med, University of Cambridge
  • C. Matula - Universitätsklinik für Neurochirurgie, Medizinische Universität Wien

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.02.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc158.shtml

Published: May 30, 2008

© 2008 Kotter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Removal of bone in the vicinity of vulnerable CNS structures with standard high speed drills is associated with a risk of mechanical and thermal injury to neural tissues. Piezosurgical bone removal, a technique based on ultrasonic microvibrations, holds the promise of significantly reducing the risk and at the same time increasing the accuracy of the procedure.

Methods: To assess whether piezosurgical bone removal is safe for underlying neural structures we have conducted a histological study comparing the effects of a frontal trepanation using standard high speed drills and piezosurgical instrumentation on the underlying rat cortex by volumetrically assessing the extent of subarachnoid hemorrhage and neural tissue destruction (27 cortical hemispheres studied in 5 experimental groups). We have subsequently used the piezoelectrical device in a clinical setting and report our experience and the functional outcome (visus/perimetry) of the use of the piezoelectrical device for optic nerve decompression (7 patients with piezosurgical bone removal/ 7 control patients).

Results: Our experimental study demonstrated that piezoelectrical bone removal is safe for underlying neural structures as even prolonged exposure of the cortical hemisphere to the piezosurgical device does not increase histological defects. Our clinical use demonstrated that piezosurgery is a safe procedure that increases the accuracy of bone removal for optic nerve decompression and is associated with a beneficial outcome.

Conclusions: Piezoelectrical surgery is a safe procedure that increases the accuracy of selective bone removal and at the same time decreases the risk of damage to adjacent nerve structures.