Farhad Islam, Onyekachi Emmanuel Anyagwa, Oluwatoyin Adalia Dairo.
Volume 2 Special Issue 1 (Feb) 2025, Article 25 (pp.61-62)
Key Points
Question:
How does pulsed laser-induced jet system (LIJS) enhance skull base tumour resection while preserving neurovascular structures? Can LIJS improve intraoperative safety and postoperative outcomes compared to traditional dissection instruments?
Findings:
LIJS enables precise tissue resection, minimizing thermal and mechanical trauma. In a study of 46 patients, LIJS preserved intratumorally arteries in over 84% of cases while preventing complications. The technology demonstrated effective devascularization and protection of adjacent structures like the cavernous sinus and optic chiasm. LIJS has been particularly useful in complex tumour resections, including pituitary adenomas and meningiomas.
Meaning:
LIJS offers a promising alternative to conventional surgical tools for skull base tumour excision. It reduces the risk of neurovascular damage while enhancing precision in tumour debulking. Future improvements in catheter design could further optimize its performance in minimally invasive neurosurgery.
Abstract
Importance:
The surgical management of skull-base and soft tissue tumors constitutes considerable challenges due to the need of preserving vital neurovascular structures; however, advancements in minimally invasive techniques, such as the transsphenoidal approach for ventral skull base lesions (e.g., pituitary tumors), have significantly enhanced outcome. These procedures continue to present dangers, including vascular damage resulting from thermal or mechanical trauma during tissue debulking. Conventional technologies such as Doppler probes and micro-hook blades are still prevalent, while recent findings report the effectiveness of water jet systems in accurate tissue resection and preservation of neurovascular structures.
Objective:
This study is focused on investigating the potential benefits of a pulsed laser-induced jet system (LIJS) for skull base tumor procedures, prioritizing intraoperative safety and improved postoperative results relative to traditional dissection instruments.
Evidence Review:
This systematic review assesses randomized clinical trials, multi-institutional studies, and experimental investigations conducted in the last decade. Data was gathered utilizing online databases, including PubMed, Cochrane and Google Scholar, with applicable search phrases. Eight relevant papers, selected using the PRISMA-P technique (refer to Figure 1), were reviewed to evaluate the utilization of LIJS in the surgical management of skull base tumors.
Findings:
Numerous institutional studies have demonstrated that utilizing pulsed LIJS for the excision of skull base tumors, especially pituitary adenomas, yields accurate tissue resection and tumor de-bulking. Our study revealed the preservation of intratumorally arteries in over 84% of cases among 46 patients. LIJS demonstrated excellent devascularization while securely preserving adjacent tissues, such as the cavernous sinus. No complications developed in any of the 46 procedures. Furthermore, its utilization in complex tumors like meningiomas, assisted in the preservation of the optic chiasm and the associated neurovascular structures.
Conclusion and Relevance:
The pulsed LIJS has demonstrated the ability to safeguard essential neurovascular systems during tumor excision, preventing heat injury or mechanical trauma usually associated with conventional micro-incisional instruments. The accurate tissue debulking it provides could substitute traditional techniques in skull base procedures. Concerns have been expressed about the system’s capacity to produce internal stress in brain tissues, which may impact the maneuverability of the jet axis. Future modifications to catheter design could enhance its efficacy in minimally invasive neurological surgeries.
