Utility of a Rotation-Suction Microdebrider for Tumor Removal in Endoscopic Endonasal Skull Base Surgery: Experience in 32 Patients

Introduction: The microdebrider is a common tool used in endoscopic sinus surgery for removing polypoid and sinonasal tissue. It uses rotating blades and an integrated suction device for controlled removal of tissue under video-endoscopic visualization. The application of the microdebrider for endoscopic removal of skull base tumors has not been previously reported. The objective of this report is to investigate the utility of the rotation-suction microdebrider as a tool for endoscopic endonasal removal of solid and fibrous skull base tumors.

Methods: Thirty-two patients underwent endoscopic endonasal skull base surgery where the rotation-suction microdebrider was used as the primary tool for tumor removal and debulking. Pathologies included a variety of anterior skull base meningiomas, sinonasal skull base malignancies, juvenile nasopharyngeal angiofibromas, schwannomas, and other skull base lesions.

Results: Gross total and near-total removal was achieved in 87.5% (28/32) of patients, and subtotal removal was performed in 12.5% (4/32) of patients. The microdebrider allowed efficient debulking and removal of solid and fibrous tumors, such as meningiomas that were not responsive to standard ultrasonic aspiration. There were no complications of orbital or neurovascular injury, or thermal injury to the nostril.

Conclusions: The rotation-suction microdebrider is a useful tool for endoscopic endonasal removal of skull base tumors. This is particularly useful for solid and fibrous tumors that are not responsive to standard ultrasonic aspiration. For intracranial tumors, it is critical to remain inside the tumor capsule during debulking to avoid injury to the surrounding neurovascular structures.