著者

Akihiko Adachi Eiichi Kobayashi Ken Kado Naokatsu Saeki

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.10, no.5, pp.236-242, 2016 (Released:2016-11-30)

参考文献数

8

被引用文献数

7 6

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Objectives: Manual shaping of a straight microcatheter is required when guiding or retention of a microcatheter with a pre-shaped tip is difficult. According to the manufacturer’s instructions, it is recommended that the microcatheter be shaped by steaming “for 30s” and “25 mm away from the steam source”. However, insufficient shaping and blunting can occasionally occur during the procedure. In this technical note, we present the optimal conditions of shaping for a microcatheter system.Methods: In this study, we used a hot air gun (BOSCH, Gerlingen, Germany) as the shaping source and a Headway microcatheter (Microvention, CA, USA; Terumo, Tokyo, Japan). After measuring the difference between the preset and the actual temperature value, shaping was performed at different temperatures (preset temperature of 110°C–140°C) and time intervals (30s–120s).Results: The actual temperature was constant at 20°C below the preset temperature, at a distance of 2.5 cm from the hot air outlet. We performed shaping at a preset temperature of 110°C–140°C (i.e., 90°C–120°C actual temperature) for 30s–120s. Because the Headway microcatheter could not tolerate preset temperature higher than 130°C (i.e., actual temperature of 110°C), the distal tip fluffed, bubbled, and perforated. We examined the durability under each condition, comparing the shape just after mandrel removal, after micro-guidewire manipulation, and after stretching in a vascular model. The highest moldability and durability were achieved at a time interval of 90s–120s, and a preset temperature of 120°C (i.e., 100°C actual temperature).Conclusion: The Headway microcatheter showed the best performance at a heating time of 90s and a preset temperature of 120°C (i.e., 100°C actual temperature) in hot air gun shaping, although the optimal temperature and time interval may vary with the used microcatheter, depending on each instrument structure and materials.

著者

Naokatsu SAEKI Kentaro HORIGUCHI Hisayuki MURAI Yuzo HASEGAWA Toyoyuki HANAZAWA Yoshitaka OKAMOTO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.50, no.9, pp.756-764, 2010 (Released:2010-09-25)

参考文献数

17

被引用文献数

15 19

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Here we describe the procedures of endoscopic pituitary and skull base surgery in our institute. We also review the literature to reveal recent advances in this field. Endonasal approach via the sphenoid ostium was carried out for pituitary lesions without the nasal speculum. Postoperative nasal packing was basically not needed in such cases. For meningiomas, craniopharyngiomas, and giant pituitary adenomas, which required intra-dural procedures, nasal procedures such as middle nasal conchotomy and posterior ethmoidectomy, and skull base techniques such as optic canal decompression and removal of the planum sphenoidale were carried out to gain a wider operative field. Navigation and ultrasonic Doppler ultrasonography were essential. Angled endoscopes allowed more successful removal of tumors under direct visualization extending into the cavernous sinus and lower clivus. If cerebrospinal fluid (CSF) leakage occurred during operation, the dural opening was covered with a vascularized mucoseptal flap obtained from the nasal septum. Lumbar drainage system to prevent postoperative CSF rhinorrhea was frequently not required. Angled suction tips, single-shaft coagulation tools, and slim and longer holding forceps, all of which were newly designed for endoscopic surgery, were essential for smoother procedures. Endonasal endoscopic pituitary surgery allows less invasive transsphenoidal surgery since no postoperative nasal packing and less dependence on lumbar drainage are needed. Endoscopic pituitary surgery will be more common and become a standard procedure. Endoscopic skull base surgery has enabled more aggressive removal of extrasellar tumors with the aid of nasal and skull base techniques. Postoperative CSF leakage is now under control due to novel methods which have been proposed to close the dural defect in a water-tight manner. Endoscopic skull base surgery is more highly specialized, so needs special techniques and surgical training. Patient selection is also important, which needs collaboration with ear, nose, and throat specialists. As a safe and successful procedure in skull base surgery, this complex procedure should be carried out only in specialized hospitals, which deal with many patients with skull base lesions.