Neurosurgery

Minimising risk with ultrasonic dissection and aspiration in surgical interventions.

Surgical interventions at the skull and spinal column are especially challenging. Access via the bony shell of the skull requires a precise and selective approach. The impairment of important neuronal and vascular structures in the brain and at the spinal column due to surgery can also lead to severe functional loss for the patient. For these reasons, the development of minimally invasive and microsurgical operative methods has received a highly positive response, especially in the area of neurosurgery.

Indications for interventions at the skull
Tumours are one of the main indications for surgical interventions at the skull. Metastases occur more often than primary brain tumours. This means that more than 20 per cent of cancer patients develop brain metastases during the course of their disease. The most common cerebral metastases occur in the case of lung cancer (30-60 per cent), breast cancer (15-40 per cent) and skin cancer (melanoma, 10 per cent).

Surgical intervention at the skull aims at removing the tumour and metastasis respectively as completely as possible. If this is not possible, surgeons try to reduce the tumour mass as far as possible. The use of neuronavigation as well as intra-operative image data helps determine the exact location of the tumours and thereby reduce the risk of damaging intact tissue and bone structures.

Tumour dissection and fast coagulation with ultrasonic instruments
Risk is minimised even further with the use of ultrasonic instruments for the fine dissection of brain tumours.
Ultrasonic dissectors can resolve tumour mass effectively ,while preserving the surrounding vessels and nerves in the process. Ultrasound or cold plasma coagulation (CPC) enables the fast spot or surface coagulation of blood vessels.

Advantages of the Söring ultrasonic instruments:

  • Precise and efficient reduction of tumour tissue
  • Prevent damage to the surrounding tissue
  • Applicable to different tissue structures such as hard, medium-hard and soft brain tumours
  • Safe handling
  • Large repertoire for different anatomical locations

Advantages of the Söring ultrasonic/ high-frequency forceps:

  • Controlled, spot coagulation
  • Surface coagulation
  • No adhesion
  • No formation of necrosis

Spinal interventions
One possible spinal intervention is the surgical decompression of the spinal canal associated with spinal stenosis. In the case of a lumbar spinal stenosis, decompression laminectomy is performed to relieve pressure on the spinal cord during which excess or disturbing bone is removed. Other spinal interventions include the removal of sequestered intervertebral disc fragments and the partial removal of vertebral bodies.

In the surgical treatment of traumatic or degenerative spinal diseases, minimally invasive techniques offer a number of advantages. These include:

  • Minimum loss of blood
  • Less postoperative pain
  • Fast mobilisation
  • Fewer wound-healing disorders and secondary complications

Ultrasonic dissection in spinal surgery
Ultrasonic dissectors in the sensitive area of the spine enable the exceptionally precise removal of bone. The great advantage of ultrasonic dissection lies in selective bone dissection, whereby only hard structures are removed without damage to the surrounding soft tissue. Bone material is removed gently and the dura mater and other nerve structures are not damaged in the process.

Advantages of the Söring ultrasonic dissectors for bone removal:

  • Selective dissection of bone and hard structures and conservation of the surrounding soft tissue
  • The surrounding nerves and vessels are preserved
  • Greatly reduced risk of damaging the dura mater

Neurosurgery temporomesiale glioma removal

Methods of treatment for Neurosurgery

Söring ultrasonic/ high frequency instruments

Generators for dissection:
The Sonoca ultrasonic generators provide an alternating current which is converted into mechanical vibrations in the converter of an ultrasonic instrument.

The surgeon has a wide range of ultrasound handpieces available for neurosurgery.

For coagulation:
The high-frequency voltage produced by the CPC generator ionises helium gas introduced by means of the handpiece and thereby generates a “cold” plasma jet at the end of the CPC probe.

The high-frequency current generated is routed through a connection cable to the CPC handpiece with corresponding CPC probe.

Indications

Cranial indications
In brain surgery, Söring ultrasonic instruments are mainly used for the removal of soft and hard tumours. The tumour mass is reduced by placing the Sonotrode into the tumour mass and then aspirating the cell fragments by means of the aspiration fluid.

Dissection:
Ultrasonic dissectors for the fine dissection of tumour tissue.

Coagulation:

  • Surface coagulation without formation of necrosis of the resected tumour cavity.
    Söring irrigation forceps
    CPC handpieces
  • Delicate spot coagulation without adhesion of tissue to the forceps tip and only minimal thermal damage to the surrounding tissue
    Söring NON-STICK bipolar irrigation forceps

Spinal indication
In spinal surgery, Söring ultrasonic bone scalpels are used for the removal of bone fragments, particularly in spinal stenosis and for the removal/ partial removal of vertebral bodies/ vertebral arches and sequestered intervertebral disc fragments.

Use of ultrasonic bone dissectors

Indications in the area of the cervical spine:

  • Endoscopic anterior cervical discectomy with canal decompression
  • Endoscopic posterior cervical laminoforaminotomy with discectomy
  • Endoscopic posterior cervical laminectomy with opposite canal decompression

Indications in the area of the lumbar spine:

  • Endoscopic lumbar discectomy
  • Open and microscopic access to the spinal column

Ultrasound Generators
Micro Pen Handpieces
Cold Plasma Coagulation
CPC Handpieces

Soring Neuro Surgery Brochure