Pulsed laser-induced liquid jet for skull base tumor removal with vascular preservation through the transsphenoidal approach: a clinical investigation
Pulsed laser-induced liquid jet for skull base tumor removal with vascular preservation through the transsphenoidal approach: a clinical investigation
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DOI：
10.1007/s00701-010-0925-x
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发表时间：
2011-04-01
影响因子：
2.4
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
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作者：
Ogawa, Yoshikazu;Nakagawa, Atsuhiro;Tominaga, Teiji
经蝶窦入路最近被用于治疗蝶鞍以外的复杂病变，但处理小血管、深而窄的空间和工作角度的困难可能限制了手术。为了克服这些问题，我们开发了一种脉冲激光诱导液体射流（LILJ）系统来解剖肿瘤组织，并在深而窄的工作空间内保留细血管，并评估其实用性和安全性。LILJ系统连续应用于14例经扩展蝶窦入路治疗的异常复杂颅底肿瘤患者。该系统由一个卡口状导管组成，导管内装有一个由不锈钢管（外径1.10 mm，内径0.78 mm）制成的射流发生器，其周围环绕着一个同轴聚四氟乙烯14g等效吸入管，以便能够融入有限的工作空间。导管可稍加修改（长度15 - 18cm，直端或侧屈端），总重量约为7g。除一例复发脊索瘤因放射引起明显纤维化外，所有病例均获得肿瘤的精确解剖和肿块缩小。小动脉和静脉均被保留，允许随后的显微手术断流。术中出血量少，肿瘤切除率满意。无与使用LILJ系统相关的并发症。虽然将来必须与传统手术器械进行比较，但本研究表明，LILJ系统可以实现复杂颅底肿瘤的安全、最佳切除。微创内窥镜系统的潜在应用，以及根据外科医生的喜好改变导管设计的低成本的潜力，可能比传统的手术器械有优势。
The transsphenoidal approach has recently been used to treat complex lesions beyond the sella turcica, but the difficulties of dealing with small vessels, deep and narrow space, and working angle may limit the procedures. To overcome these problems, we have developed a pulsed laser-induced liquid jet (LILJ) system to dissect tumor tissue with preservation of fine blood vessels within deep and narrow working spaces and evaluated its utility and safety.The LILJ system was applied to 14 consecutive patients with uncharacteristically complex skull base tumor treated through the extended transsphenoidal approach. This system consists of a bayonet-shaped catheter incorporating a jet generator formed of stainless tube (external diameter 1.10 mm, internal diameter 0.78 mm), which was surrounded by a coaxial polytetrafluoroethylene 14-G equivalent suction tube to be able to incorporate into the confined working spaces. Minor modifications could be fitted for the catheter (15 to 18 cm length, straight or side flexion tip), and total weight was around 7 g.Precise dissection and mass reduction of the tumor were obtained in all cases except one recurrent case of chordoma with significant fibrosis due to radiation. Both small arteries and veins were preserved, allowing subsequent microsurgical devascularization. Intraoperative blood loss was minimal, and tumor removal rate was satisfactory after the introduction of the system. No complication was related to use of the LILJ system.Although comparison between conventional surgical instruments is mandatory in the future, the present study suggests that the LILJ system can achieve safe and optimum removal of complex skull base tumor. Potential application for minimally invasive endoscopic system, as well as potentials for changing the design of the catheter in according to preference of surgeon with low cost, may give advantages over conventional surgical instruments.