Our Summary

Craniotomy, a procedure that involves opening the skull, is a common surgical procedure but it can lead to serious complications. A new technique called piezosurgery (PS) uses a blade that vibrates at a microscopic level to cut bone. This technique has been shown to reduce complications, but there is still a risk of damage to the brain’s protective covering (dura) and blood vessels.

To further reduce these risks, researchers used a system called neuronavigation, which allows surgeons to track their instruments in real-time using images from brain scans. They tested this neuronavigated PS technique on two patients who were having surgery for a condition called trigeminal neuralgia, which causes severe facial pain.

Before the surgery, the patients had brain scans using magnetic resonance imaging and computed tomography. The PS cutter was calibrated using a neuronavigation system. During the surgery, the surgeon could see the position and path of the blade on a monitor as it cut into the bone. This allowed them to stop the blade before it caused any damage to the dura or blood vessels. After the surgery, the pieces of skull that were removed were replaced perfectly without the need for additional devices to hold them in place.

The results showed that using neuronavigation with PS could potentially reduce the risk of complications associated with craniotomy. By providing real-time images of the blade’s position, surgeons can avoid causing damage to crucial parts of the brain. The researchers believe the principles behind this technique could pave the way for the use of robotic surgery in the future.

FAQs

  1. What is piezosurgery and how does it improve craniotomy procedures?
  2. How does the S8 StealthStation neuronavigation system work with piezosurgery in a craniotomy?
  3. What potential benefits and decreases in complication rates does neuronavigated piezosurgery offer in craniotomy procedures?

Doctor’s Tip

A doctor might tell a patient undergoing a craniotomy to ask about the use of neuronavigation technology during the procedure. This technology can help decrease the risk of complications by allowing the surgeon to visualize the position and trajectory of the surgical instrument in real-time, potentially preventing dural lacerations and neurovascular injuries.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, traumatic brain injuries, vascular malformations, epilepsy, trigeminal neuralgia, and other conditions that require access to the brain for treatment or diagnosis. Additionally, patients who have failed conservative treatments or who have conditions that are not responsive to medications may also be candidates for craniotomy. In the cases described in the study, miniretromastoid craniotomy was performed for trigeminal neuralgia using neuronavigated piezosurgery, highlighting the potential benefits of this technique in reducing complications during the procedure.

Timeline

Before craniotomy:

  • Patient undergoes volumetric brain magnetic resonance imaging and computed tomography
  • Surgeon plans the surgery and decides on the approach and technique to be used
  • Patient is informed about the procedure, risks, and benefits
  • Pre-operative assessments are done to ensure the patient is fit for surgery

During craniotomy:

  • Patient is taken to the operating room and placed under general anesthesia
  • Surgeon performs the craniotomy using the chosen technique (in this case, neuronavigated piezosurgery)
  • Neuronavigation system helps the surgeon track the instrument’s position and trajectory while cutting the bone
  • Surgeon carefully removes the bone flap without damaging the dura or neurovascular structures
  • Once the procedure is completed, the bone flap is repositioned without the need for fixation devices

After craniotomy:

  • Patient is closely monitored in the recovery room for any immediate post-operative complications
  • Patient may experience pain, swelling, and discomfort at the surgical site
  • Depending on the reason for craniotomy, further treatment or rehabilitation may be needed
  • Follow-up appointments are scheduled to monitor the patient’s recovery and address any concerns or complications

What to Ask Your Doctor

  1. What is the purpose of the craniotomy procedure?
  2. What are the potential risks and complications associated with craniotomy?
  3. How will neuronavigation technology be used during the procedure?
  4. How does piezosurgery differ from traditional craniotomy techniques?
  5. How long is the recovery process expected to be after a craniotomy?
  6. Will I need any follow-up appointments or monitoring after the procedure?
  7. Are there any specific post-operative care instructions I should follow?
  8. How experienced is the surgical team in performing craniotomy procedures?
  9. What are the success rates for craniotomy in treating my specific condition?
  10. Are there any alternative treatment options to consider before proceeding with craniotomy?

Reference

Authors: Ferroli P, Iess G, Bonomo G, Raccuia G, Broggi M. Journal: World Neurosurg. 2022 Feb;158:148-151. doi: 10.1016/j.wneu.2021.11.059. Epub 2021 Nov 18. PMID: 34800729