超音波メスの使い方 聴神経鞘腫の手術

Abstract

The goal of acoustic neuroma surgery is to accomplish total removal of the tumor with functional preservation of the facial and cochlear nerves. A conventional ultrasonic aspirator is too large and heavy for performance of fine and delicate surgical maneuvers. We developed a compact and light-weight handpiece suitable for acoustic neuroma surgery. The handgrip is designed to fit the surgeon's hand, and is well balanced. Suction pressure can be controlled with a finger by closing or opening a hole set in the handpiece. The horn portion is exchangeable for one with a different tip diameter; the smallest diameter is 1.5 mm. This ultrasonic aspirator has been used in 48 acoustic neuroma operations. The aspirator enabled removal of a relatively hard tumor including one in the internal auditory canal quickly, without damage to the surrounding tissue. The maneuverability of the aspirator is similar to the conventional suction tube, in view of the suction-pressure control system and handgrip. Holding a regular suction tube in one hand and the ultrasonic aspirator in the other is the most convenient method for removing a tumor safely because the surgeon can always confirm the amount and nature of the residual tumor by touching the tumor with the regular suction tip.