Beyin ve Omurilik Tümörlerinin Cerrahi Tedavisinde Doku Seçici Ultrasonik Aspiratörlerin Kullanılması
Abstract
Amaç: Ultrasonik cerrahi aspiratörler yüksek frekanslı ses dalgaları ile çalışan cerrahi aletlerdir. Tümör cerrahisinde dokuya seçici ultrasonik aspiratörlerin kullanılması ile normal nöral dokuya en az zarar verecek şekilde beyin ve/veya omurilik tümörlerinin güvenle çıkartılması mümkündür. Ameliyat süresinin kısalması ve hastaya sağladığı yararların dışında hastane işletmesi açısından da maddi tasarruf sağlanmasını mümkün kılabilir. Bu çalışmanın amacı santral sinir sistemi tümörlerinde ultrasonik aspiratörün yarar ve uygulanabilirliğini değerlendirmektir.
Gereç ve Yöntemler: Mart 2013 ve Eylül 2017 tarihleri arasında beyin veya omurilik tümörü nedeniyle Düzce Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalına başvuran, beyin veya omurilik tümörü nedeniyle ameliyatı yapılan 40 hasta çalışmaya alınmıştır. Ameliyat sırasında ultrasonik aspiratör kullanılmış ve ameliyat süreleri kaydedilmiştir.
Bulgular: Ameliyatları ultrasonik aspiratör kullanılarak yapılan grup ile ultrasonik aspiratör kullanmadan yapılan gruplar arasında toplam operasyon süresi karşılaştırılmıştır. Ultrasonik aspiratör kullanılan grupta ortalama ameliyat süresinin anlamlı düzeyde yüksek olduğu tespit edilmiştir (253,8±87,5; 195,4±48,7; p=0,014). Oysa ultrasonik aspiratör kullanımının glioblastoma tanılı hastalarda ameliyat süresini değiştirmediği tespit edilmiştir (237,8±56,3; 235,5±31,9; p=0,689).
Sonuç: Cerrahi tedavinin bir parçası haline gelen teknolojik aletler, en az hasar ile maksimum verim alınmasını sağlayan cihazlardır. Ancak bu cihazlar nasıl kullanılacakları konusunda önceden eğitim gerektirirler. Ultrasonik aspiratör kullanımında yardımcı sağlık personelinin eğitimi çok önemlidir. Bu konuda yardımcı sağlık personelinin eğitiminin ardından yapılacak daha fazla çalışmalara ihtiyaç vardır.
References
- Shores A. Use of the ultrasonic aspirator in intracranial surgery: technique and case reports. Prog Vet Neurol. 1991;2:89-94.
- Shores A. Intracranial surgery. In: Slatter DH, editor. Textbook of small animal surgery. 2nd ed. Philadelphia, PA: Saunders; 1993. p.1122-35.
- Greco JJ, Aiken SA, Berg JM, Monette S, Bergman PJ. Evaluation of intracranial meningioma resection with a surgical aspirator in dogs: 17 cases (1996-2004). J Am Vet Med Assoc. 2006;229(3):394-400.
- Forterre F, Dickomeit M, Senn D, Gorgas D, Spreng D. Microfenestration using the CUSA Excel ultrasonic aspiration system in chondrodystrophic dogs with thoracolumbar disk extrusion: a descriptive cadaveric and clinical study. Vet Surg. 2011;40(1):34-9.
- Young W, Cohen AR, Hunt CD, Ransohoff J. Acute physiological effects of ultrasonic vibrations on nervous tissue. Neurosurgery. 1981;8(6):689-94.
- Wladis EJ, Kenning TJ. Cavitron ultrasonic surgical aspirator-assisted resection of combined orbital and intracranial tumors. Orbit. 2014;33(3):234-5.
- Tang H, Zhang H, Xie Q, Gong Y, Zheng M, Wang D, et al. Application of CUSA Excel ultrasonic aspiration system in resection of skull base meningiomas. Chin J Cancer Res. 2014;26(6):653-7.
- Carrabba G, Mandonnet E, Fava E, Capelle L, Gaini SM, Duffau H, et al. Transient inhibition of motor function induced by the Cavitron ultrasonic surgical aspirator during brain mapping. Neurosurgery. 2008;63(1):E178-9.
- Malhotra V, Malik R, Gondal R, Beohar PC, Parkash B. Evaluation of histological appearance of tissues removed by cavitron ultrasonic surgical aspirator (CUSA). Acta Neurochir (Wien). 1986;81(3-4):132-4.
- Blackie RA, Gordon A. Histological appearances of intracranial biopsies obtained using the Cavitron ultrasonic surgical aspirator. J Clin Pathol. 1984;37(10):1101-4.
- Schroeteler J, Reeker R, SueroMolina E, Brokinkel B, Holling M, Grauer OM, et al. Glioma tissue obtained by modern ultrasonic aspiration with a simple sterile suction trap for primary cell culture and pathological evaluation. Eur Surg Res. 2014;53(1-4):37-42.
- Tang H, Sun H, Xie L, Tang Q, Gong Y, Mao Y, et al. Intraoperative ultrasound assistance in resection of intracranial meningiomas. Chin J Cancer Res. 2013;25(3):339-45.
- Jallo GI. CUSA Excel ultrasonic aspiration system. Neurosurgery. 2001;48(3):695-7.
The Use of Tissue-Selective Ultrasonic Aspirators in the Surgical Treatment of Brain and Spinal Cord Tumors
Abstract
Aim: Ultrasonic surgical aspirators are surgical instruments operated with high frequency sound waves. The brain and/or spinal cord tumors can be removed safely with minimal damaging to neurovascular structures by using tissue-selective ultrasonic aspirators. Besides its benefits to the patient, by shortening the duration of operation, it may also provide cost savings in terms of hospital management. The aim of this study is to evaluate the utility and feasibility of ultrasonic aspirator in central nervous system tumors.
Material and Methods: Forty patients who apply to the Department of Neurosurgery at Duzce University Medical Faculty between March 2013 and September 2017 due to brain or spinal cord tumor and operated for a brain or spinal cord tumor were included. Ultrasonic aspirator was used during the operations, and duration of operations were recorded.
Results: The total operation time was compared between the groups that their operations performed by using ultrasonic aspirator and by not using it. The mean operation time was significantly higher in the group performed operations by using ultrasonic aspirator (253.8±87.5, 195.4±48.7, p=0.014). Whereas ultrasonic aspirator usage did not change the duration of operation in patients with glioblastoma (237.8±56.3, 235.5±31.9, p=0.689).
Conclusion: Technological instruments, that become a part of surgical treatment, are devices that ensure maximum efficiency with minimum damage. However, these devices require prior training on how to use them. Training of healthcare staff in the use of ultrasonic aspirator is very important. Further studies are needed following the training of the assistant healthcare staff in this subject.
References
- Shores A. Use of the ultrasonic aspirator in intracranial surgery: technique and case reports. Prog Vet Neurol. 1991;2:89-94.
- Shores A. Intracranial surgery. In: Slatter DH, editor. Textbook of small animal surgery. 2nd ed. Philadelphia, PA: Saunders; 1993. p.1122-35.
- Greco JJ, Aiken SA, Berg JM, Monette S, Bergman PJ. Evaluation of intracranial meningioma resection with a surgical aspirator in dogs: 17 cases (1996-2004). J Am Vet Med Assoc. 2006;229(3):394-400.
- Forterre F, Dickomeit M, Senn D, Gorgas D, Spreng D. Microfenestration using the CUSA Excel ultrasonic aspiration system in chondrodystrophic dogs with thoracolumbar disk extrusion: a descriptive cadaveric and clinical study. Vet Surg. 2011;40(1):34-9.
- Young W, Cohen AR, Hunt CD, Ransohoff J. Acute physiological effects of ultrasonic vibrations on nervous tissue. Neurosurgery. 1981;8(6):689-94.
- Wladis EJ, Kenning TJ. Cavitron ultrasonic surgical aspirator-assisted resection of combined orbital and intracranial tumors. Orbit. 2014;33(3):234-5.
- Tang H, Zhang H, Xie Q, Gong Y, Zheng M, Wang D, et al. Application of CUSA Excel ultrasonic aspiration system in resection of skull base meningiomas. Chin J Cancer Res. 2014;26(6):653-7.
- Carrabba G, Mandonnet E, Fava E, Capelle L, Gaini SM, Duffau H, et al. Transient inhibition of motor function induced by the Cavitron ultrasonic surgical aspirator during brain mapping. Neurosurgery. 2008;63(1):E178-9.
- Malhotra V, Malik R, Gondal R, Beohar PC, Parkash B. Evaluation of histological appearance of tissues removed by cavitron ultrasonic surgical aspirator (CUSA). Acta Neurochir (Wien). 1986;81(3-4):132-4.
- Blackie RA, Gordon A. Histological appearances of intracranial biopsies obtained using the Cavitron ultrasonic surgical aspirator. J Clin Pathol. 1984;37(10):1101-4.
- Schroeteler J, Reeker R, SueroMolina E, Brokinkel B, Holling M, Grauer OM, et al. Glioma tissue obtained by modern ultrasonic aspiration with a simple sterile suction trap for primary cell culture and pathological evaluation. Eur Surg Res. 2014;53(1-4):37-42.
- Tang H, Sun H, Xie L, Tang Q, Gong Y, Mao Y, et al. Intraoperative ultrasound assistance in resection of intracranial meningiomas. Chin J Cancer Res. 2013;25(3):339-45.
- Jallo GI. CUSA Excel ultrasonic aspiration system. Neurosurgery. 2001;48(3):695-7.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 30, 2019 |
| Submission Date | April 24, 2019 |
| Published in Issue | Year 2019 Volume: 21 Issue: 2 |
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