Bi-Bole Bipolar Coagulation in the Resection of Challenging Intracranial Lesions: Analysis of Surgical Advantages

Background: Achieving effective hemostasis, while minimizing collateral heat transfer, can be extremely challenging during electrocoagulation of hypervascular and critically located intracranial lesions.

Object: This study was aimed to present and analyze the physical properties and the surgical advantages of the ball-tipped bipolar (BTB) coagulation instrument.

Methods: Deep heat generation was assessed using a mathematical equation incorporating the geometrical configuration of the bipolar electrode tips. Function curves were compared between the ball-tipped and the traditional forceps instruments. To illustrate and define the surgical indications of the instrument, challenging intracranial lesions operated on using BTB coagulation were retrospectively reviewed. Lesion features included hypervascularity and/or giant size and/or close proximity to eloquent neurovascular structures.

Results: BTB coagulation resulted in decreased deep heat generation compared with traditional bipolar forceps, allowing the application of higher power levels. Nine patients underwent surgery using BTB coagulation for 12 different challenging intracranial lesions. Given the large mean size of the tumors (39.1 cm³) and their frequent adherence to the brainstem and major veins and venous sinuses, many cases were previously deemed inoperable. Gross total resection was achieved in 8 of 12 procedures. Mean estimated operative blood loss was 541 mL. Average KPS significantly improved 6 months after surgery (p = 0.005) and none of the patients presented radiological or clinical evidence of adjacent neurovascular injury.

Conclusion: BTB coagulation maximizes hemostasis by increasing contact surface and by reducing inadvertent deep thermal dispersion. It is particularly useful for devascularizing, debulking and shrinking of large hypervascular lesions, especially those with skull base feeders and/or arising close to arteries, veins, venous sinuses, cranial nerves, and normal neural tissue.

Publication History

Article published online:
12 February 2021