HAND-HELD THULIUM LASER FIBER AND ULTRASONIC ASPIRATOR FOR OPENING THE INTERNAL AUDITORY CANAL DURING ACOUSTIC NEUROMA MICRONEUROSURGERY: OPERATIVE TECHNIQUE

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Luciano Mastronardi, MD, PhD

Department of Neurosurgery – San Filippo Neri Hospital, ASLRoma 1, Rome, Italy

INTRODUCTION This surgical video describes the new technologies used for microsurgery removal of acoustic neuromas (AN) and in particular for opening the internal auditory canal (IAC). In particular, hand-held flexible 2μ-Thulium laser fiber and Sonopet Ultrasound Aspirator are used for a safe and easier opening of the IAC.

We illustrate the operative technique used on a surgical serie of 111 cases operated on during the last 8 years.

MATERIALS AND METHODS From July, 2010 to July, 2018, 180 consecutive patients suffering from AN have been operated on with microsurgical technique by key-hole retrosigmoid (RS) approach. In 111 cases “Sonopet” Ultrasound Aspirator was used for the opening of the internal auditory canal (IAC) and a 2μ-Thulium laser fiber was used for cutting the dura mater of the posterior aspect of pertrous bone and of the acoustic meatus, and it was also used to perform tumor capsule incision.

From December 2017 we started to check the removal of tumor inside the fundus of IAC with the flexible endoscope in order to detect possible tumoral residues and achieving a radical tumor resection of tumor.

CONCLUSIONS The use of Hand-held flexible laser fiber and Sonopet Ultrasound Aspirator seems to be safe and subjectively facilitate the opening of the IAC in AN microsurgery.

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