Piezosurgery Applications in Skull Base Surgery

Background: Skull base surgery involves frequent dissection of the bony skull base around critical neurovascular structures. Current tools for bone dissection such as the drill or saw are dangerous as they can cause significant collateral damage to these structures, thus potentially altering functional outcomes after skull base surgery. Piezosurgery, due to its soft tissue sparing and hemostatic effects, enables safe, precise and atraumatic bone dissection with the potential of expanding the capabilities of skull base surgery and reducing the associated functional morbidity. We demonstrate the various applications of piezosurgery in different skull base regions.

Methods: Retrospective case series of three skull base cases in the anterior, middle, and posterior cranial fossa using piezosurgery. An anterolateral skull base approach, a middle cranial fossa approach, and a translabyrinthine approach were performed; piezosurgery was used to dissect or expose dural and neurovascular structures under nerve monitoring. Operation time, macroscopic preservation, and functional preservation were monitored and correlated with postoperative function. Any complications were correlated with the different phases of surgery and the instruments used.

Results: Operation times were comparable to conventional procedures. Dural integrity was maintained, and the extent of bone removal was increased by piezosurgery. Dissection and exposure of neurovascular structures was achieved with macroscopic preservation and no functional irritation of neural structures. No surgical complications occurred.

Conclusion: Piezosurgery increases the extent and radicality of bone removal possible through anatomic and integrity-preserving dissection of critical neurovascular structures in the bony skull base. This enhances exposure and access in various skull base regions.