Comparing use of the Sonopet<sup>®</sup> ultrasonic bone aspirator to traditional instrumentation during the endoscopic transsphenoidal approach in pituitary tumor resection

Baddour, H. Michael; Lupa, Michael; Patel, Zara M.

doi:10.1002/alr.21143

Cited by 31 publications

(31 citation statements)

References 25 publications

(37 reference statements)

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“…Indeed, the main technique of endoscopic tumor resection in the early years was the use of angled scissors and cutting instruments, whereas technologically advanced instrumentation like the side-cutting aspiration device or ultrasonic surgical aspirators have only been very recently introduced in EES, and they may need further improvement for adequate results. 3,30,33 The absence of cortical cuff as a factor in reduced GTR rates in EES actually reflects the absence of clear arachnoid plane between the tumor and the brain parenchyma/neurovascular structures, which represents a challenge regardless of the surgical approach. Although advanced age was not a limitation for GTR with EES (Table 5), advanced age and coexisting comorbidities were the main indicators that changed the goal of surgery toward less aggressive resections.…”

Section: Surgical Outcomementioning

confidence: 99%

Endoscopic Endonasal Surgery for Olfactory Groove Meningiomas: Outcomes and Limitations in 50 Patients

et al. 2015

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M eningioMas of the olfactory groove arise from the region of the frontosphenoidal suture and may involve any part of the area from the crista galli to the planum sphenoidale. 21,31,35,39 Given their slow growth pattern and subfrontal location, olfactory groove meningiomas present insidiously and frequently achieve large size before detection. 21,39 Removal of small to midsize tumors usually is not difficult, but resecting large tumors and/or those that infiltrate or surround adjacent structures becomes challenging. Various surgical approaches have been advocated to resect olfactory groove meningiomas, with the subfrontal (unilateral or bilateral) and pterional approaches being the most popular. 1,4,6,11,20,21,31,39 Recently, technological advances (angled endoscopes, specialized instrumentation, image guidance, neurophysiological monitoring) and increasing experience have expanded the indications

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Section: Surgical Outcomementioning

confidence: 99%

Endoscopic Endonasal Surgery for Olfactory Groove Meningiomas: Outcomes and Limitations in 50 Patients

et al. 2015

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Section: Surgical Outcomementioning

confidence: 99%

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

107

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Object Recently, endoscopic endonasal surgery (EES) has been introduced in the management of skull base tumors, with constantly improving outcomes and increasing indications. The authors retrospectively reviewed the effectiveness of EES in the management of olfactory groove meningiomas. Methods Between February 2003 and December 2012, 50 patients (64% female) with olfactory groove meningiomas underwent EES at the University of Pittsburgh Medical Center. The authors present the results of EES and analyze the resection rates, clinical outcome, complications, and limitations of this approach. Results Forty-four patients presented with primary tumors, whereas six were previously treated elsewhere. The patients’ mean age was 57.1 years (range 27–88 years). Clinical presentation included altered mental status (36%), visual loss (30%), headache (24%), and seizures (20%). The mean maximum tumor diameter was 41.6 mm (range 18–80 mm). All patients underwent EES, which was performed in stages in 18 giant tumors. Complete tumor resection (Simpson Grade I) was achieved in 66.7% of the 45 patients in whom it was the goal, and 13 (28.9%) had near-total resection (> 95% of the tumor). Tumor size, calcification, and absence of cortical cuff from vasculature were significant factors that influenced the degree of resection (p = 0.002, p = 0.024, and p = 0.028, respectively). Tumor residual was usually at the most lateral and anterior tumor margins. Following EES, mental status was improved or normalized in 77.8% of the cases, vision was improved or restored in 86.7 %, and headaches resolved in 83.3 %. There was no postoperative deterioration of presenting symptoms. Complications were increased in tumors > 40 mm and included CSF leakage (30%), which was significantly associated with lobular tumor configuration (p = 0.048); pulmonary embolism/deep vein thrombosis, more commonly in elderly patients (20%); sinus infections (10%); and delayed abscess months or years after EES (6%). One patient had an intraoperative vascular injury resulting in transient hemiparesis (2%). There were no perioperative deaths. During a mean follow-up period of 32 months (median 22 months, range 1–115 months), 1 patient underwent repeat EES for tumor regrowth. Conclusions Endoscopic endonasal surgery has shown good clinical outcomes regardless of patient age, previous treatment, or tumor characteristics. Tumor size > 40 mm, calcification, and absence of cortical vascular cuff limit GTR with EES; in addition, large tumors are associated with increased postoperative complications. Significant lateral and anterior dural involvement may represent indications for using traditional craniotomies for the management of these tumors. Postoperative CSF leakage remains a problem that necessitates innovations in EES reconstruction techniques.

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“…Studies have established the superiority of the Sonopet in manipulating bone and soft tissue when compared to conventional drills, demonstrating increased precision with decreased operative time and decreased blood loss 6. The instrument has been found to be efficacious in endoscopic skull base surgery, allowing the surgeon to carefully aspirate bone during trans-sphenoidal approaches and complex skull base tumour resections 6…”

Section: Discussionmentioning

confidence: 99%

Osteoradionecrosis of the hyoid bone – a novel application of the Sonopet ultrasonic aspirator

Gill

Joshi

2014

BMJ Case Reports

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A 66-year-old man with a history of squamous cell carcinoma of the right tonsil presented to the emergency department with two life-threatening episodes of haemoptysis 9 months after completion of chemoradiation. He was evaluated to rule out recurrent malignancy, and was determined to have osteoradionecrosis of his hyoid bone that had led to an oropharyngeal fistula. Given the proximity to branches of the external carotid, he was offered tracheostomy and resection of the protruding necrotic bone with ultrasonic bone aspirator, which was placed down the shaft of the laryngoscope to minimise damage to adjacent structures. He tolerated the procedure well with complete resolution of exposed bone on follow-up laryngoscopy.

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Comparing use of the Sonopet^® ultrasonic bone aspirator to traditional instrumentation during the endoscopic transsphenoidal approach in pituitary tumor resection

Cited by 31 publications

References 25 publications

Endoscopic Endonasal Surgery for Olfactory Groove Meningiomas: Outcomes and Limitations in 50 Patients

Endoscopic Endonasal Surgery for Olfactory Groove Meningiomas: Outcomes and Limitations in 50 Patients

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Osteoradionecrosis of the hyoid bone – a novel application of the Sonopet ultrasonic aspirator

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Comparing use of the Sonopet® ultrasonic bone aspirator to traditional instrumentation during the endoscopic transsphenoidal approach in pituitary tumor resection

Cited by 31 publications

References 25 publications

Endoscopic Endonasal Surgery for Olfactory Groove Meningiomas: Outcomes and Limitations in 50 Patients

Endoscopic Endonasal Surgery for Olfactory Groove Meningiomas: Outcomes and Limitations in 50 Patients

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Osteoradionecrosis of the hyoid bone – a novel application of the Sonopet ultrasonic aspirator

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Comparing use of the Sonopet^® ultrasonic bone aspirator to traditional instrumentation during the endoscopic transsphenoidal approach in pituitary tumor resection