Artikel
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
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Autoren
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M.R. Kotter
- Universitätsklinik für Neurochirurgie, Medizinische Universität Wien
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G. Widhalm
- Universitätsklinik für Neurochirurgie, Medizinische Universität Wien
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R. Vig
- Universitätsklinik für Neurochirurgie, Medizinische Universität Wien
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H. Widhalm
- Universitätsklinik für Unfallchirurgie, Medizinische Universität Wien
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R. J. M. Franklin
- Cambridge Centre for Brain Repair, Dept Clin Vet Med, University of Cambridge
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C. Matula
- Universitätsklinik für Neurochirurgie, Medizinische Universität Wien
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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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.
