title: Pulsed Laser-induced Liquid Jet System for Treatment of Sellar and Parasellar Tumors: Safety Evaluation.
abstract: OBJECTIVE
  The pulsed laser-induced liquid jet (LILJ) system is an emerging surgical instrument intended to assist both maximal removal of the lesion and functional maintenance through preservation of fine vessels and minimal damage to the surrounding tissue. The system ejects the minimum required amount of pulsed water through a handy bayonet-shaped catheter. We have already shown a significant increase in removal rate, in addition to a noteworthy reduction of intraoperative blood loss and procedure time in the treatment of large pituitary and skull base tumors in a single-institution series. The present study evaluated the safety of the system in multiple institutions.
  
  
  METHODS
  The study included 46 patients, 29 men and 17 women (mean age: 59.1 years) who underwent microsurgical/endoscopic resection of lesions in or in the vicinity of the pituitary fossa through the transsphenoidal approach between October 2011 and June 2012 at six institutions. The histologic diagnoses were pituitary adenoma (31 cases), meningioma (4), craniopharyngioma (3), cavernous angioma (2), and Rathke cyst cleft (1). Lesion volume ranged from 2.0 to 30.4 cm³ (mean: 3.7 cm³). Cavernous sinus invasion was observed in 11 cases and suprasellar extension in 29 cases.
  
  
  RESULTS
  Preservation of intralesional arteries (diameter: 150 µm) was achieved in all situations in > 80% of cases. Intended surgical steps were achieved except for some restrictions in motion due to the use of an optical quartz fiber. No complications occurred directly related to the use of the device.
  
  
  CONCLUSIONS
  The LILJ system can be used for safe removal of lesions in or in the vicinity of the pituitary fossa.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ogawa
authors.affiliation: Department of Neurosurgery, Tokyo Woman's Medical University, Tokyo, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Amano
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Yudo
authors.initials: Y
authors.lastname: Ishii
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Shigeshi
authors.initials: S
authors.lastname: Tahara
authors.affiliation: Department of Neurosurgery, Chiba University, Chiba, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Horiguchi
authors.affiliation: Department of Neurosurgery, Tokyo Woman's Medical University, Tokyo, Japan.
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawamata
authors.affiliation: Department of Neurosurgery, Kumamoto University Graduate School, Kumamoto, Japan.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Yano
authors.affiliation: Department of Bioengineering, The University of Tokyo, Tokyo, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Arafune
authors.affiliation: Human Technology Research Institute, National Institutes for Advanced Industrial and Scientific Technology, Tsukuba, Japan.
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Washio
authors.affiliation: Department of Neurosurgery, Faculty of Life Sciences Research, Kumamoto University Graduate School, Kumamoto, Japan.
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kuratsu
authors.affiliation: Department of Neurosurgery, Chiba University, Chiba, Japan.
authors.forename: Naokatsu
authors.initials: N
authors.lastname: Saeki
authors.affiliation: Department of Neurosurgery, Tokyo Woman's Medical University, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Teramoto
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000592:standards; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000592:standards*; D017063:Outcome Assessment, Health Care; D011673:Pulsatile Flow; D012658:Sella Turcica / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D014867:Water
chemical_list: D014867:Water