title: Pulsed laser-induced liquid jet for skull base tumor removal with vascular preservation through the transsphenoidal approach: a clinical investigation.
abstract: BACKGROUND
  The transsphenoidal approach has recently been used to treat complex lesions beyond the sella turcica, but the difficulties of dealing with small vessels, deep and narrow space, and working angle may limit the procedures. To overcome these problems, we have developed a pulsed laser-induced liquid jet (LILJ) system to dissect tumor tissue with preservation of fine blood vessels within deep and narrow working spaces and evaluated its utility and safety.
  
  
  METHODS
  The LILJ system was applied to 14 consecutive patients with uncharacteristically complex skull base tumor treated through the extended transsphenoidal approach. This system consists of a bayonet-shaped catheter incorporating a jet generator formed of stainless tube (external diameter 1.10 mm, internal diameter 0.78 mm), which was surrounded by a coaxial polytetrafluoroethylene 14-G equivalent suction tube to be able to incorporate into the confined working spaces. Minor modifications could be fitted for the catheter (15 to 18 cm length, straight or side flexion tip), and total weight was around 7 g.
  
  
  RESULTS
  Precise dissection and mass reduction of the tumor were obtained in all cases except one recurrent case of chordoma with significant fibrosis due to radiation. Both small arteries and veins were preserved, allowing subsequent microsurgical devascularization. Intraoperative blood loss was minimal, and tumor removal rate was satisfactory after the introduction of the system. No complication was related to use of the LILJ system.
  
  
  CONCLUSIONS
  Although comparison between conventional surgical instruments is mandatory in the future, the present study suggests that the LILJ system can achieve safe and optimum removal of complex skull base tumor. Potential application for minimally invasive endoscopic system, as well as potentials for changing the design of the catheter in according to preference of surgeon with low cost, may give advantages over conventional surgical instruments.
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, Nagamachiminami, Taihaku-ku, Sendai, Miyagi, Japan. yogawa@kohnan-sendai.or.jp
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Takayama
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000236:Adenoma / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002817:Chordoma / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation*; D004724:Endoscopy / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D007552:Isotonic Solutions; D053685:Laser Therapy / Q000295:instrumentation*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D010911:Pituitary Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D000077325:Ringer's Lactate; D019291:Skull Base / Q000098:blood supply* / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000098:blood supply* / Q000175:diagnosis / Q000601:surgery*; D013101:Sphenoid Sinus / Q000098:blood supply* / Q000601:surgery; D055815:Young Adult
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate