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Collateral thermal injury during endoscopic skull base surgery from endonasal CO2 laser and coblation

Published online by Cambridge University Press:  10 April 2013

D Chin ,
K Snidvongs ,
R Sacks  and
R J Harvey
D Chin*
Affiliation:
Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia Department of Otolaryngology, Head and Neck Surgery, Changi General Hospital, Singapore
K Snidvongs
Affiliation:
Advanced School of Medicine, Macquarie University Hospital, Sydney, Australia Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
R Sacks
Affiliation:
Advanced School of Medicine, Macquarie University Hospital, Sydney, Australia Faculty of Medicine, The University of Sydney, Sydney, Australia Department of Otolaryngology, Head and Neck Surgery, Concord Repatriation General Hospital, Sydney, Australia
R J Harvey
Affiliation:
Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia Advanced School of Medicine, Macquarie University Hospital, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia
*
Address for correspondence: Dr David Chin, 354 Victoria St, Darlinghurst, NSW, Australia2010 Fax: +61 (0)293 609919 E-mail: drdavidchin@gmail.com
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Abstract

Introduction:

Effective tissue removal techniques are essential in endoscopic skull base surgery. Improvements in technology permit more accurate application of CO2 laser and coblation during endonasal procedures. This study assessed the thermal injury patterns associated with fibre CO2 laser and coblation.

Methods:

Fresh frozen cadaveric heads were used. Mucosal removal was performed at the ethmoid roof. Structured lesions were created using either CO2 laser or coblation. The corresponding thermal injury patterns on dural tissue were assessed and compared between the two groups.

Results:

Five cadaveric heads were obtained; five sides received CO2 laser lesions and five coblation lesions. Forty per cent (n = two sides) of the CO2 specimens had macroscopic foci of grey-black discolouration on the dural aspect. No macroscopic dural changes were seen in the coblation specimens.

Conclusion:

Dural injury was seen following CO2 laser use despite attempts to avoid it. Both CO2 laser and coblation have their advantages; however, the lower thermal working power of coblation and superior depth control may make it more suitable for endoscopic endonasal periorbital and peridural surgery.

Keywords

Endoscopic Surgical ProceduresSkull BaseLasersInjuries
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Supplement S2 , July 2013 , pp. S29 - S32
Copyright
Copyright © JLO (1984) Limited 2013 

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