title: Use of piezosurgery for internal auditory canal drilling in acoustic neuroma surgery.
abstract: BACKGROUND
  Piezosurgery is based on microvibrations generated by the piezoelectrical effect and has a selective bone-cutting ability with preservation of soft tissue. This study examined the applicability of Piezosurgery compared to rotating drills (RD) for internal auditory canal (IAC) opening in acoustic neuroma (AN) surgery.
  
  
  METHODS
  Piezosurgery was used in eight patients for IAC drilling in AN surgery. After exposition of the IAC and tumor, the posterior wall of the IAC was drilled using Piezosurgery instead of RD. Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, preservation of cranial nerves, influences on neurophysiological monitoring, and facial nerve and hearing outcome.
  
  
  RESULTS
  Piezosurgery was successfully used for selective bone cutting, while cranial nerves were structurally and functionally preserved, which could be measured by means of neuromonitoring. Piezosurgery guaranteed a safe and precise cut by removing bone layer by layer in a shaping way. Compared to RD, limited influence on neurophysiological monitoring attributable to Piezosurgery was noted, allowing for continuous neuromonitoring. No disadvantage due to microvibrations was noticed concerning hearing function. The angled tip showed better handling in right-sided than in left-sided tumors in the hands of a right-handed surgeon. The short, thick handpiece may be improved for more convenient handling.
  
  
  CONCLUSIONS
  Piezosurgery is a safe tool for selective bone cutting for opening of the IAC with preservation of facial nerve and hearing function in AN surgery. Piezosurgery has the potential to replace RD for this indication because of its safe and precise bone-cutting properties.
authors.affiliation: Department of Neurosurgery, Albert Ludwig University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany. juergen.grauvogel@uniklinik-freiburg.de
authors.forename: Juergen
authors.initials: J
authors.lastname: Grauvogel
authors.forename: Christian
authors.initials: C
authors.lastname: Scheiwe
authors.forename: Jan
authors.initials: J
authors.lastname: Kaminsky
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D010579:Petrous Bone / Q000601:surgery*; D059745:Piezosurgery / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D000159:Vestibulocochlear Nerve / Q000473:pathology / Q000601:surgery*