Comparative Analysis of Surgical Drill Attachments for Enhanced Maneuverability in Skull Base Approaches

Introduction: Precise access and techniques are crucial in neurosurgical procedures involving the skull base to achieve optimal outcomes. In pursuit of this goal, continuous innovation has led to the development of surgical instruments designed to facilitate access within narrow surgical corridors. Among these instruments, the surgical drill is one of the most commonly used. While traditional attachments for the surgical drill have been either straight or curved, a recent introduction is the angled attachment. This study aims to compare the surgical maneuverability of straight, curved, and angled drill attachments in the context of the endonasal endoscopic approach.

Methods: We conducted anatomical dissections on six de-identified cadaveric heads injected with latex. Prior to dissection, high-resolution computed tomography scans were obtained. An endonasal endoscopic approach was performed, and we identified three points of interest: a mid-clival point, a para-clival point, and a mid-dorsum sellar point. We measured the angle of attack (AoA) along both horizontal and vertical planes and compared these measurements among the different drill attachments. To calculate the AoA, the distal end of the drill was anchored in place on the target point, while the proximal end was moved to its maximum point along both vertical and horizontal axes. Cartesian coordinates for calculating the AoA were obtained by aligning the proximal end of the drill with the tip of a neuro-navigation probe. We used ANOVA tests with Bonferroni post hoc tests to compare the AoA measurements.

Results: For the mid-clival point, the vertical AoA measurements for the straight, curved, and angled attachments were 4.4° ± 0°, 6.5° ± 1.7°, and 7.4° ± 0.7°, respectively. There was a significant increase in AoA between the angled and straight attachments (p = 0.043), but no significant differences were observed in other comparisons or in horizontal AoA measurements. Regarding the dorsum sellar point, both vertical and horizontal AoA were higher for the angled attachment compared to the straight attachment (p = 0.039 and p = 0.023, respectively). Finally, there were no significant differences in either horizontal or vertical AoA among the three attachments for the para-clival point (p > 0.05).

Conclusion: Understanding the surgical maneuverability of drill attachments is essential for selecting the most suitable instrument for each approach. The angled attachment appears to be superior to the straight one in the context of midline targets such as the dorsum sellae and mid-clival regions. However, no significant differences were observed between the straight and curved attachments.

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Artikel online veröffentlicht:
05. Februar 2024