Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy

Technical note

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✓Extradural unroofing of the optic canal and subsequent mobilization of the optic nerve is a useful technique in the surgical treatment of parasellar tumors; however, the drilling procedure itself is associated with the risk of optic nerve damage. A safer technique would certainly be beneficial. The ultrasonic bone curette is a device developed in Japan for safer bone removal. Its use in intradural anterior clinoidectomy and opening of the internal auditory meatus has been reported before. In this article the authors describe their experience in using this device for extradural unroofing of the optic canal in patients with parasellar tumors.

Between March 2002 and November 2004, the aforementioned technique was used in the treatment of eight patients with parasellar tumors. After undertaking a frontotemporal craniotomy and orbital osteotomy, an ultrasonic bone curette was used to unroof the optic canal via an epidural approach; in five cases anterior clinoidectomy was added subsequently.

Using an ultrasonic bone curette, unroofing of the optic canal was completed safely and required much less expertise than that required for standard drilling. The mortality and major morbidity rates were 0%. The visual function outcome was satisfactory, with the overall visual status improving in all seven patients in whom this symptom was present preoperatively. The ultrasonic bone curette makes the unroofing of the optic canal safer and easier, possibly improving the visual outcome of patients undergoing surgery for parasellar tumors.

Abbreviation used in this paper:ACP = anterior clinoid process.
Article Information

Contributor Notes

Address reprint requests to: Han Soo Chang, M.D., Department of Neurological Surgery, Aichi Medical University, Yazako-Karimata, Nagakute-cho, Aichi-gun, Aichi, 480–1195, Japan. email: chang@aichi-med-u.ac.jp.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Akabane ASaito KSuzuki YShibuya MSugita K: Monitoring visual evoked potentials during retraction of the canine optic nerve: protective effect of unroofing the optic canal. J Neurosurg 82:2842871995

    • Search Google Scholar
    • Export Citation
  • 2

    Al-Mefty O: Clinoidal meningiomas. J Neurosurg 73:8408491990

  • 3

    Al-Mefty O: Meningiomas of the anterior cranial base. Operative Atlas of Meningiomas PhiladelphiaLippincott-Raven1998. 166

  • 4

    Day JDGiannotta SLFukushima T: Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 81:2302351994

    • Search Google Scholar
    • Export Citation
  • 5

    DeMonte F: Surgical treatment of anterior basal meningiomas. J Neurooncol 29:2392481996

  • 6

    Dolenc VV: Elements of the epidural approach to the parasellar space and adjacent regions in the central skull base. Microsurgical Anatomy and Surgery of the Central Skull Base WienSpringer-Verlag2003. 5172

    • Search Google Scholar
    • Export Citation
  • 7

    Goel AMuzumdar DDesai KI: Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 51:135813642002

    • Search Google Scholar
    • Export Citation
  • 8

    Hadeishi HSuzuki AYasui NSatou Y: Anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette. Neurosurgery 52:8678712003

    • Search Google Scholar
    • Export Citation
  • 9

    Jallo GIBenjamin V: Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 51:143214402002

  • 10

    Lee JHJeun SSEvans JKosmorsky G: Surgical management of clinoidal meningiomas. Neurosurgery 48:101210212001

  • 11

    Rosenstein JSymon L: Surgical management of suprasellar meningioma. Part 2: prognosis for visual function following craniotomy. J Neurosurg 61:6416481984

    • Search Google Scholar
    • Export Citation
  • 12

    Samii MAmmirati M: Surgery of Skull Base Meningiomas BerlinSpringer-Verlag1992. 3541

  • 13

    Takahashi JAKawarazaki AHashimoto N: Intradural en-bloc removal of the anterior clinoid process. Acta Neurochir (Wien) 146:5055092004

    • Search Google Scholar
    • Export Citation
  • 14

    Tobias SKim CHKosmorsky GLee JH: Management of surgical clinoidal meningiomas. Neurosurg Focus 14:6E52003

  • 15

    Yaşargil MG: Microneurosurgery Vol IVB StuttgartThieme1996. 134165

  • 16

    Yonekawa YOgata NImhof HGOlivecrona MStrommer KKwak TE: Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg 87:6366421997

    • Search Google Scholar
    • Export Citation
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