Piezosurgery: An Innovative and Safe Technique to Approach Cerebral Lesions

Introduction: Piezosurgery is an alternative surgical tool, which uses ultrasounds for bone cutting, without harming surrounding soft tissues. The advantages are practicability, safety, preciseness of bone cutting with less heat damage of the bone, faster bone healing and potentially preservation of neurovascular structures.

Methods: From January 2009 to January 2021, a total of 134 patients were treated using piezosurgery in our department. 21 were parasagittal craniotomy, 38 to a presigmoid and retro or translabyrinthine approach associated to the opening of posterior wall of internal acoustic meatus, 33 to a restrosigmoid approach, 17 to an anterior transpetrosus approach and 25 to a pterional approach with clinoidectomy. The piezo-osteotome was used in 82 cases to perform the craniotomy, in 19 cases the clinoidectomy, in 10 cases the petrosectomy, in 16 cases to thin the orbit's roof, and in 14 cases to open the posterior wall of the internal acoustic meatus. All patients were evaluated with pre and postoperative CT scan, and after three and six month with 3D bone reconstruction.

Results: No Venous sinus rupture occurred. Only in two cases occurred a venous sinus thrombosis, not necessarily related to the craniotomy step. No post-operative CSF fistula occurred. The ossification rate of the craniotomic borders was 70% at three months and over 90% at nine month. In no cases, bone resorption or mobilization has been documented. The use of piezosurgery to perform clinoidectomy, petrosectomy and to thin the acoustic internal meatus did not cause damage to the neuro-vascular structures. The only real drawback is the longer surgical time in comparison of traditional pneumatic tools.

Conclusion: Piezosurgery is a new promising technique for selective bone cutting with soft tissue preservation. These characteristics make this tool particularly attractive in skull base surgery because it allows performing osteotomies also near neurovascular structures and eloquent areas.

Publication History

Article published online:
15 February 2022