Abstract
Objective: To report the physical and technical principles, clinical applications, and outcomes of the minimal invasive piezoelectric osteotomy in a consecutive veterinary neurosurgical series. Methods: A series of 292 dogs and 32 cats underwent an osteotomy because a neurosurgical pathology performed with a Mectron Piezosurgery® bone scalpel (Mectron Medical Technology, Genoa, Italy) was retrospectively reviewed. Efficacy, precision, safety, and blood loss were evaluated intraoperatively by two different surgeons, on a case-by-case basis. Postoperative Rx and CT scans were used to assess the selectivity and precision of the osteotomy. A histological study on bony specimens at the osteotomized surface was carried out to evaluate the effects of piezoelectric cutting on the osteocytes and osteoblasts. All the patients underwent a six-months follow-up. A series of illustrative cases was reported. Results: All the osteotomies were clear-cut and precise. A complete sparing of soft and nervous tissues and vasculature was observed. The operative field was blood- and heat-free in all cases. A range of inserts, largely different in shape and length, were allowed to treat deep and difficult-to-reach sites. Two mechanical complications occurred. Average blood loss in dogs’ group was 52, 47, and 56 mL for traumatic, degenerative, and neoplastic lesions, respectively, whereas it was 25 mL for traumatized cats. A fast recovery of functions was observed in most of the treated cases, early on, at the first sixth-month evaluation. Histology on bone flaps showed the presence of live osteocytes and osteoblasts at the osteotomized surface in 92% of cases. Conclusions: Piezosurgery is based on the physical principle of the indirect piezo effect. Piezoelectric osteotomy is selective, effective, and safe in bone cutting during neurosurgical veterinary procedures. It can be considered a minimal invasive technique, as it is able to spare the neighboring soft tissues and neurovascular structures.
Highlights
Piezoelectric osteotomy is based upon the mechanical effect of ultrasound, which is increased by physical phenomenon of cavitation.Vet
The input coming from a high-pressure source causes collapse of these cavities and generates a shock wave, which propagates in the tissue
The purpose of this study is to report the overall results of a consecutive retrospective veterinary series where piezoelectric surgery was employed for neurosurgical procedures
Summary
Piezoelectric osteotomy is based upon the mechanical effect of ultrasound, which is increased by physical phenomenon of cavitation.Vet. Piezoelectric osteotomy is based upon the mechanical effect of ultrasound, which is increased by physical phenomenon of cavitation. Microvibrations of the ultrasonic frequency are linear in shape and micrometric (60–210 μm). They allow us to selectively cut the bone without significant damage to the underlying soft and neurovascular tissues [1–11]. The cavitation phenomenon involves the formation of vapor-filled cavities secondary to the abrupt and rapid changes of pressure in a liquid. The input coming from a high-pressure source causes collapse of these cavities and generates a shock wave, which propagates in the tissue. The shock wave causes cell detachment from the substrate and significant changes in focal adhesion and biomechanics, inducing a mechanical cut on the mineralized tissue [14–17]
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