Artikel
A new technique for stereotactically guided burr whole trepanantion simplifies the workflow of stereotactic surgery
Eine neue Technik für stereotaktisch geführte Bohrlochtrepanationen vereinfacht den Arbeitsablauf bei stereotaktischen Operationen
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Autoren
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Daniel Rueß
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
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Stephanie T. Jünger
- Universitätsklinikum Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
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Ulrich Koopmann
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
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Veerle Visser-Vandewalle
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
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Maximilian I. Ruge
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Stereotactic procedures usually require burr whole trepanation. To date, there is virtually no CE-certified drilling system that can be integrated into a stereotactic apparatus and thus permits stereotactically guided trepanations. Thus, free-hand burr whole trepanation are still the standard of care and often require time-consuming osteoclastic expansions.
Methods: We developed a novel drill (HiCUTTM, Adeor) which can be picked up by a standard cordless screwdriver (Colibri IITM, DePuy Synthes) and a novel guide sleeve (Instrument guide ID:10mm RM rail holder, Inomed) which can be easily integrated into a stereotactic system (RM-System, Inomed). This setup allows the stereotactic guidance of the drill. An unpaired t-test and chi-square test was used to compare the stereotactically guided trepanation (SGT) with freehand trepanation (FHT) using a trepane (Meridian classicTM, Adeor) in terms of time for trepanation, time from trepanation to dura incision, and if additional surgical measurements (osteoclastic expansion, hemostasis) were necessary.
Results: Overall 84 trepanations (SGT: n=27, FHT=57) for stereotactic biopsies were observed. The mean time for completing the burr whole was 58 s ± 36 and showed no difference between both groups (p=0.485). The mean time until dura incision was significantly (p=0.018) reduced when using SGT (FTH: 304 s ±170 vs SGT: 136 s ± 89). Additional osteoclastic expansion was frequently necessary in the FHT group (81% (n=46) vs 3.7%, (n=1), p<0.001). Similar results were observed for hemostasis which was significantly less necessary in the SGT group (71% (n=41) vs 40%, (n=11), p=0.006). We did not observe any differences between specialists and trainees for all these parameters.
Conclusion: SGT significantly shortens the time until dura opening compared to FHT. Additionally, time-consuming hemostasis and osteoclastic expansions are no longer necessary when using SGT. Furthermore, SGT seems to be successfully applied regardless of the surgeon`s level of training.
