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Tissue dissection before direct manipulation to the pathology with pulsed laser-induced liquid jet system in skull base surgery—preservation of fine vessels and maintained optic nerve function

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Abstract

Background

Most difficulties in skull base tumor removal are generally caused by adhesion of feeding arteries to the vital structures and cranial nerves. Water jet technology provides tissue dissectability with preservation of fine blood vessels both in experimental and clinical situations. However problems still remain regarding whether tumor removal with preservation of peripheral nerve function is possible or not. This clinical investigation evaluated functional preservation of peripheral nerves and dissectability with a newly developed pulsed laser-induced liquid jet (LILJ) system under intraoperative electrophysiological monitoring.

Methods

The LILJ system was used to treat 21 patients with skull base tumors manifesting as severe visual disturbance through the extended transsphenoidal approach. The LILJ system consists of a bayonet-shaped catheter incorporating a jet generator, and total weight is around 7 g. Intraoperative visual evoked potential (VEP), and pre/postoperative conventional visual assessments were investigated.

Results

Precise dissections of the tumor were obtained, resulting in gross total removal in 19 of 21 patients. Two patients with meningiomas with tight adhesion to the origin of the lenticulostriate arteries had small remnants. Of the 21 patients, 16 showed immediate improvement on intraoperative VEP, 2 had no change, and 3 had prolonged latency, which required intermittent suspension of procedure. A total of 20 patients and 40 eyes showed good recovery at discharge, and all patients evaluated had recovered good visual status.

Conclusions

The LILJ system can achieve safe and optimal removal with functional preservation of optic nerves, probably because of the high resistance of the arachnoidal sheath and fine vascular tissue.

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Conflicts of interest

None

Sources of financial and material support

This work was partially funded by Ministry of Economy, Trade, and Industry, Japan as a part of Program to support collaboration between hospitals and businesses for development and improvement of medical equipment and devices to solve unmet medical needs (supplementary budget, 2010FY ZEN 219 to YO, AN, and TT); a Grant-in-Aid for Scientific Research (B) (No. 18390388 to AN), Grants-in-Aid for Young Scientists (A) (Nos. 19689028 and 22689039 to AN), and Challenging Exploratory Research (Nos. 21659313 to AN and 24592152 to YO and AN) from the Japanese Ministry of Education, Culture, Sports, Science, and Technology; the Japanese Foundation for Research and Promotion of Endoscopy Grant (to TN and AN); the Tohoku University Exploratory Research Program for Young Scientists (to AN); the Collaborative Research Project of the Institute of Fluid Science, Tohoku University (to AN); and Ogino Research Facilitating award from Japanese Society of Biomedical Engineering (to AN).

Author information

Correspondence to Yoshikazu Ogawa.

Supplemental video

Below is the link to the electronic supplementary material.

This case was a soft meningioma, which could be partially de-bulked by the LILJ system. Video that demonstrates tissue dissection with fine artery preservation, 1.05 min, 25.2 MB. (MPG 25828 kb)

This case was a soft meningioma, which could be partially de-bulked by the LILJ system. Video that demonstrates tissue dissection with fine artery preservation, 1.05 min, 25.2 MB. (MPG 25828 kb)

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Ogawa, Y., Nakagawa, A., Washio, T. et al. Tissue dissection before direct manipulation to the pathology with pulsed laser-induced liquid jet system in skull base surgery—preservation of fine vessels and maintained optic nerve function. Acta Neurochir 155, 1879–1886 (2013). https://doi.org/10.1007/s00701-013-1817-7

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Keywords

  • Cranial nerve
  • Functional preservation
  • Ho:YAG laser
  • Skull base tumor
  • Vascular preservation
  • Water jet