Abstract
Objective:
We report the use of an ultrasonic bone curette to perform endoscopic-assisted anterior skull base resection of a sinonasal fibrosarcoma. While the use of high-speed drills has become common for this procedure, we report the efficacy and advantages of using this alternative method. This is the first reported case of said procedure.
Methods and Results:
The Sonopet Ultrasonic Aspirator simultaneously provides fragmentation of tissue by rapid longitudinal motion, irrigation by coaxial flow at the tip of the device, and aspiration of irrigant and fragmented tissue. This allows for removal of bone with less trauma to surrounding structures including dura. We report a 50-year-old man who underwent an endoscopically assisted anterior skull base resection of a fibrosarcoma of the posterior wall of the frontal sinus and its outflow tract just anterior and lateral to the cribriform plate. Initially, an endoscopic biopsy of the lesion was performed. After pathologic diagnosis was concluded and fibrosarcoma identified, the extirpation was completed. The endoscopic-assisted operation used a 70-degree telescope intranasally and the Sonopet Ultrasonic Aspirator through a Lynch-Howarth incision. The supraorbital, anterior, and posterior walls of the left frontal sinus were removed using the bone aspirator. An anterior fossa dural tear was repaired using Alloderm intraoperatively, and no postoperative complications were encountered. All tumor margins were negative. The patient was discharged from the hospital on postoperative day 2 and has had no recurrence.
Conclusion:
Utilization of the Sonopet Ultrasonic Aspirator provides a safe and effective alternative/complement to the use of high-speed drills in endoscopic-assisted skull base surgery.