Orbit, 2014; 33(3): 234–235 ! Informa Healthcare USA, Inc. ISSN: 0167-6830 print / 1744-5108 online DOI: 10.3109/01676830.2013.873811
LETTER TO THE EDITOR
Cavitron Ultrasonic Surgical Aspirator-Assisted Resection of Combined Orbital and Intracranial Tumors Edward J. Wladis1 and Tyler J. Kenning2 1
Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA and 2Department of Neurosurgery, Albany Medical College, Albany, New York, USA
phacoemulsification, the CUSA was utilized to ‘‘shave’’ the lesion. The simultaneous aspiration and irrigation functions of the CUSA offer exceptional visualization and facilitate bimanual surgery, in which the free hand can retract the orbital fat. CUSA tip diameters measure 3–4 mm,6 enabling entrance of the instrument into confined spaces. All patients experienced decreased proptosis and had stable or improved vision post-operatively. No patient experienced a complication related to the use of the CUSA or damage to surrounding orbital structures. The resections were essentially bloodless, and no patient required coagulation of the lesion or adjunctive hemostatic materials. The CUSA employs ultrasonic technology, and similar handpieces to those employed in phacoemulsification. Ophthalmologists have significant facility
Resection of orbito-cranial lesions necessitates delicate, interdisciplinary approaches to retain or enhance vision.1 The cavitron ultrasonic surgical aspirator (CUSA) operates at a frequency that is selective for tissue with high water content and provides constant aspiration, dissection, and irrigation.2 Based on these properties, it removes lesions hemostatically with minimal trauma to surrounding tissue. We have utilized the CUSA in the management of four orbito-cranial masses (see Table 1). In all cases, a frontotemporal craniotomy was fashioned, the orbital roof and lateral wall were removed, the periorbita was incised, and dissection was carried out to delineate the lesion. The CUSA handpiece is similar to phacoemulsification instrumentation (see Figure 1), and a foot pedal initiates aspiration and irrigation. As with
TABLE 1. Clinical characteristics of the patients on whom the CUSA technology was employed. Patient#
Age (years)
Gender
Histopathologic findings/diagnosis
Presenting ophthalmic symptoms and signs
Post-operative result
Complications
4 mm of proptosis
None
2 mm of proptosis, resolution of diplopia 2 mm of proptosis
None
1 mm of proptosis, 20/400 vision
None
1
26
Male
Meningioma
2
46
Female
Grade I Spheno-orbital Meningioma
16 mm of ipsilateral proptosis, no light perception 6 mm of ipsilateral proptosis, diplopia
3
12
Male
4
61
Female
Optic Nerve Pilocytic astrocytoma Grade II Spheno-orbital Meningioma
9 mm of ipsilateral proptosis, no light perception 6 mm of ipsilateral proptosis, hand motion vision
None
Received 11 October 2013; Revised 2 December 2013; Accepted 4 December 2013; Published online 7 January 2014 Correspondence: Edward J. Wladis, Department of Ophthalmology, Lions Eye Institute, Albany Medical College, 1220 New Scotland Rd., Slingerlands 12159, USA, Tel: 518-533-6540, Fax: 518-533-6542, E-mail: [email protected]
234
CUSA in Orbital Surgery
235
with this instrumentation, and should be aware of its utility in the resection of skull base neoplasms.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES 1. Margalit N, Ezer H, Fliss DM, et al. Orbital tumors treated using transcranial approaches: surgical technique and neuroophthalmogical results in 41 patients. J Neurosurg 2007;23:e11. 2. Carabba G, Mandonnet E, Fava E, et al. Transient inhibition of motor function induced by the cavitron ultrasonic surgical aspirator during brain mapping. Neurosurg 2008; 63:E178–179.
FIGURE 1. External CUSA unit.
!
intraoperative
2014 Informa Healthcare USA, Inc.
photograph
of
the
Copyright of Orbit is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER TO THE EDITOR
Cavitron Ultrasonic Surgical Aspirator-Assisted Resection of Combined Orbital and Intracranial Tumors Edward J. Wladis1 and Tyler J. Kenning2 1
Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA and 2Department of Neurosurgery, Albany Medical College, Albany, New York, USA
phacoemulsification, the CUSA was utilized to ‘‘shave’’ the lesion. The simultaneous aspiration and irrigation functions of the CUSA offer exceptional visualization and facilitate bimanual surgery, in which the free hand can retract the orbital fat. CUSA tip diameters measure 3–4 mm,6 enabling entrance of the instrument into confined spaces. All patients experienced decreased proptosis and had stable or improved vision post-operatively. No patient experienced a complication related to the use of the CUSA or damage to surrounding orbital structures. The resections were essentially bloodless, and no patient required coagulation of the lesion or adjunctive hemostatic materials. The CUSA employs ultrasonic technology, and similar handpieces to those employed in phacoemulsification. Ophthalmologists have significant facility
Resection of orbito-cranial lesions necessitates delicate, interdisciplinary approaches to retain or enhance vision.1 The cavitron ultrasonic surgical aspirator (CUSA) operates at a frequency that is selective for tissue with high water content and provides constant aspiration, dissection, and irrigation.2 Based on these properties, it removes lesions hemostatically with minimal trauma to surrounding tissue. We have utilized the CUSA in the management of four orbito-cranial masses (see Table 1). In all cases, a frontotemporal craniotomy was fashioned, the orbital roof and lateral wall were removed, the periorbita was incised, and dissection was carried out to delineate the lesion. The CUSA handpiece is similar to phacoemulsification instrumentation (see Figure 1), and a foot pedal initiates aspiration and irrigation. As with
TABLE 1. Clinical characteristics of the patients on whom the CUSA technology was employed. Patient#
Age (years)
Gender
Histopathologic findings/diagnosis
Presenting ophthalmic symptoms and signs
Post-operative result
Complications
4 mm of proptosis
None
2 mm of proptosis, resolution of diplopia 2 mm of proptosis
None
1 mm of proptosis, 20/400 vision
None
1
26
Male
Meningioma
2
46
Female
Grade I Spheno-orbital Meningioma
16 mm of ipsilateral proptosis, no light perception 6 mm of ipsilateral proptosis, diplopia
3
12
Male
4
61
Female
Optic Nerve Pilocytic astrocytoma Grade II Spheno-orbital Meningioma
9 mm of ipsilateral proptosis, no light perception 6 mm of ipsilateral proptosis, hand motion vision
None
Received 11 October 2013; Revised 2 December 2013; Accepted 4 December 2013; Published online 7 January 2014 Correspondence: Edward J. Wladis, Department of Ophthalmology, Lions Eye Institute, Albany Medical College, 1220 New Scotland Rd., Slingerlands 12159, USA, Tel: 518-533-6540, Fax: 518-533-6542, E-mail: [email protected]
234
CUSA in Orbital Surgery
235
with this instrumentation, and should be aware of its utility in the resection of skull base neoplasms.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES 1. Margalit N, Ezer H, Fliss DM, et al. Orbital tumors treated using transcranial approaches: surgical technique and neuroophthalmogical results in 41 patients. J Neurosurg 2007;23:e11. 2. Carabba G, Mandonnet E, Fava E, et al. Transient inhibition of motor function induced by the cavitron ultrasonic surgical aspirator during brain mapping. Neurosurg 2008; 63:E178–179.
FIGURE 1. External CUSA unit.
!
intraoperative
2014 Informa Healthcare USA, Inc.
photograph
of
the
Copyright of Orbit is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
