Ultrasonic aspiration in neurosurgery: comparative analysis of complications and outcome for three commonly used models

Abstract

IntroductionUltrasonic aspiration (UA) devices are commonly used for resecting intracranial tumors, as they allow for internal debulking of large tumors, hereby avoiding damage to adjacent brain tissue during the dissection. Little is known about their comparative safety profiles.Methods and materialsWe analyzed data from a prospective patient registry. Procedures using one of the following UA models were included: Integra® CUSA, Söring®, and Stryker® Sonopet. The primary endpoint was morbidity at discharge, defined as significant worsening on the Karnofsky Performance Scale. Secondary endpoints included morbidity and mortality until 3 months postoperative (M3), occurrence, type, and etiology of complications.ResultsOf n = 1028 procedures, the CUSA was used in n = 354 (34.4 %), the Söring in n = 461 (44.8 %), and the Sonopet in n = 213 (20.7 %). There was some heterogeneity of study groups. In multivariable analysis, patients in the Söring (adjusted odds ratio (aOR) 1.29; 95 % confidence interval (CI), 0.80–2.08; p = 0.299), and Sonopet group (aOR, 0.86; 95 % CI, 0.46–1.61; p = 0.645) were as likely as patients in the CUSA group to experience discharge morbidity. At M3, patients in the Söring (aOR, 1.20; 95 % CI, 0.78–1.86; p = 0.415) and Sonopet group (aOR, 0.53; 95 % CI, 0.26–1.08; p = 0.080) were as likely as patients in the CUSA group to experience morbidity. There were also no differences for M3 morbidity in subgroup analyses for gliomas, meningiomas, and metastases. The grade (p = 0.608) and etiology (p = 0.849) of postoperative complications were similar.ConclusionsNeurosurgeons select UA types with regard to certain case-specific characteristics. The safety profiles of three commonly used UA types appear mostly similar.Electronic supplementary materialThe online version of this article (10.1007/s00701-019-04021-0) contains supplementary material, which is available to authorized users.

Diagnosis and Surgical Management of Exophytic Suprasellar Pituitary Adenoma Extending Over the Diaphragma Sellae and Mimicking Craniopharyngioma: A Case Report

“…We prepared an ultrasonic aspiration device to resect the tumor from the vessels and nerves. Ultrasonic transducers limit the damage to blood vessels and nerves during tumor resection due to tissue selection, which is beneficial for patient prognosis [ 13 ]. In cases where the tumor extends into the supra-diaphragm region, these devices are considered safe for use in surgery.…”

Utilization of Discarded Surgical Tissue from Ultrasonic Aspirators to Establish Patient‐Derived Metastatic Brain Tumor Cells: A Guide from the Operating Room to the Research Laboratory

“…1), is the most commonly used, and is the focus of this article, although the SONOPET system made by Stryker is also widely used. There have been few studies directly comparing the two systems, but a review of the available literature concludes that they seem to be functionally interchangeable (Henzi, Krayenbühl, Bozinov, Regli, & Stienen, 2019).…”

FFPE samples from cavitational ultrasonic surgical aspirates are suitable for RNA profiling of gliomas

“…The cavitational ultrasonic surgical aspirator (CUSA) is currently indispensable in neurosurgery departments to partially fragment the tumour before surgical resection of the intracranial mass defined by magnetic resonance imaging. The action of CUSA minimizes the damage of surrounding brain tissue and blood vessels, increasing the safety and surgical precision while reducing the duration of the brain surgery and the probability of postoperative complications [1][2][3].…”