Introduction: High-speed drills are commonly used in skull base surgery but pose some risks related
to heat induction and direct tissue injury, especially in anterior clinoidectomy.
Piezosurgical devices show some benefits, mostly for the integrated peristaltic pump,
which provides continuous irrigation and heat reduction, and for the absence of spinning
instruments, which are frequently responsible for direct injuries.
Objective: To describe the novel application of the piezoelectric BoneScapel in anterior clinoidectomy
and posterior fossa surgery.
Methods: We report our initial experience with the use of an ultrasonic bone dissector (BoneScapel,
Misonix) to perform anterior clinoidectomy and posterior fossa craniotomy. The safety
and efficacy of the piezoelectric osteotomy were analyzed in a retrospective cohort
of patients with skull base oncologic and vascular pathologies.
Results: A total of 12 patients were retrospectively reviewed: 8 (66.7%) treated for posterior
fossa tumors, 3 (25%) for anterior skull base neoplasms, and 1 (8.3%) for a right
MCA aneurysm. Posterior fossa craniotomies were performed in 8 patients through median
suboccipital or retrosigmoid approaches. Mean intraoperative blood loss was 150 mL
(range, 75–300), and no lesions to the superior sagittal sinus nor the transverse
sinus were reported. Of note, only one case of dural tear was documented in one patient
treated for a cerebellar renal metastasis. Anterior clinoidectomy was successfully
performed with the ultrasonic bone dissector in all 4 patients with anterior skull
base pathologies. Mean surgical time to complete the clinoidectomy was ~22 minutes
(range, 18–25), and mean intraoperative blood loss was 156 mL (range, 43–270). No
heat damage to paraclinoid structures was noted, and postoperative courses were uneventful,
with a mean follow-up of 21 months (range, 3–72). We compared our results with the
literature reporting the use of conventional high-speed drills and Piezosurgery. We
found that the duration of craniotomies was slightly superior with BoneScapel and
Piezosurgery compared with standard osteotomies, but no time differences in completing
the anterior clinoidectomy were found between BoneScapel and conventional high-speed
drill.
Conclusion: We report our first experience with BoneScapel for anterior clinoidectomy and posterior
fossa craniotomy. In comparison to conventional high-speed drill, piezosurgery has
some advantages in reducing the surgical risks related to heat induction and direct
surgical damage, showing low rates of post-operative complication and favorable operative
times.
