ASOPRSFall Scientific SymposiumSyllabus
191
T36
TheRoleof theCavitronUltrasonic Surgical Aspirator in theResectionOf
Combined Intracranial AndOrbital Neoplasms
EdwardWladis, Tyler Kenning. Lions Eye Institute, Department of Ophthalmology, AlbanyMedical College, OphthalmicPlasticSurgery,
Albany, NY, UnitedStates
Introduction:
Surgical management of combined intracranial and orbital neoplasms provides a unique challenge, and reported
complications have included infection, hemorrhage, incomplete resection, and persistent diplopia and vision loss
1,2
.The cavitron
ultrasonic surgical aspirator (CUSA) provides constant irrigation, dissection, and aspiration and oscillates at a frequencywhich is
selective for tissuewith highwater and low collagen content, and thus resects tumorswithminimal trauma to the surrounding soft
tissue and vasculature.While this instrument has been employed in neurosurgical resections for decades
3
, its use has not been
extensively described in the orbital surgery literature.This report was designed to provide the largest depiction of the use of the
CUSA in the resection of orbital tumors.
Methods:
Retrospective review of resections of combined intracranial and orbital neoplasms. Cases inwhich the CUSAwas utilized
were compared to previous resections performed by the same surgical team at the same institution, and statistical analyseswere
performed to compare operative time and estimated blood loss.Analyses of post-operative results and complicationswere assessed.
Results:
Six patients (4 females, twomales,mean age= 30.2 years) underwent surgical resection of combined intracranial
and orbital tumorswith the CUSA.As compared to historical controls, the operating timewas significantly shorter (p<0.05) and
the estimated blood losswas significantly reduced (p<0.05) with the use of the CUSA. Postoperatively, all patients experienced
significant reduction in proptosis, diplopia resolved in all patients that presentedwith this chief complaint, and all patients that
presentedwith optic neuropathy developed improvement in their vision and resolution of optic nerve edema.
Conclusions:
The CUSA dramatically reduced operative time, and, given its
ability to simultaneously irrigate and resect orbital neoplasms, afforded the
opportunity to retract soft tissuewith a “free hand” andmarkedly enhanced
tumor resection. Furthermore, given the relative sparing of the tumor vasculature
associatedwith this device, the CUSA significantly estimated blood loss.The
CUSA utilizes technology and a handpiece that are similar to phacoemulsification
equipment,meaning that orbital surgeons can easily adopt this technique in the
management of this complex problem.
References:
1.Margalit N, Ezer H, Fliss DM, et al. J Neurosurg, 23: e11, 2007.
2. Kang JK, Lee IW, Jeun SS, et al. Childs Nerv Syst, 13: 536-41, 1997.
3. JalloGI. Neurosurg, 47: 695-7, 2001.
DetailedProgram
—Thursday,October 16, 2014
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