Use of ultrasonic aspiration for dural opening in cranial reoperations: technical note.
OBJECTIVE
Dural detachment from the brain in cranial reoperations has been accomplished previously by selective coagulation and the cutting of brain-dural adhesions. The results of ultrasonic aspiration during tumor surgery or brain cutting procedures led the authors to speculate that the detachment of the dura mater from brain tumors by applying the Cavitron ultrasonic surgical aspirator (Valleylab, Boulder, CO [formerly Cavitron, Inc., Stamford, CT]) to the brain-dura mater interface could be used to reduce bleeding and facilitate dural opening during cranial reoperations.


METHODS
Ten patients underwent a second craniotomy for epilepsy surgery (five cases of extended temporal lobectomy and five cases of extended extratemporal lesionectomy). The use of ultrasonic aspiration and its effects on brain separation from the dura mater were examined.


RESULTS
Intraoperative use of the Cavitron ultrasonic surgical aspirator during dural opening produced immediate blanching of the dura mater and enhanced visualization of the cortical surface without distortion of the brain anatomy.


CONCLUSIONS
Incremental dural opening and brain visualization is achieved by careful application of ultrasonic aspiration directly into the brain-dura limit, producing immediate regional dural devascularization. Use of this technique reduces cortical and dural bleeding and enhances the ease and effectiveness of brain visualization.
Department of Neurosurgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA. galarzamarcelo@hotmail.com
Marcelo
M
Galarza
Sandeep
S
Sood
Hugo B
HB
Pomata
D004388:Dura Mater / Q000601:surgery*; D004827:Epilepsy / Q000628:therapy*; D006801:Humans; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D013396:Suction / Q000295:instrumentation / Q000379:methods*; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation / Q000379:methods*