J Neurol Surg B Skull Base 2014; 75 - a036
DOI: 10.1055/s-0034-1383942

Tissue Dissection before Direct Manipulation to the Pathology with Pulsed Laser-Induced Liquid Jet System in Skull Base Surgery

Yoshikazu Ogawa 1, A. Nakagawa 1, T. Washio 1, T. Arafune 1, T. Tominaga 1
  • 1Department of Neurosurgery, Kohnan Hospital, Japan

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. However, problems are still remaining whether tumor removal with preservation of peripheral nerve function is possible or not. This investigation evaluated functional preservation of peripheral nerves and dissectability with 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 tumor manifesting as severe visual disturbance. 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 lenticulostriate arteries had small remnants. Overall 16 of the 21 patients showed immediate improvement on 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.