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A Protected Microknife System for Safe and Ergonomic Dural Incision in Endoscopic Endonasal Surgery: A Technical Note
Jacopo Berardineli1, Ilaria Bove1, Carmela Palmiero1
1Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi di Napoli "Federico II", Naples, Italy.
World Neurosurgery
|July 7, 2026
Summary
A modified microknife with a protective sheath enhances safety and ergonomics for dural incision during endoscopic endonasal approach (EEA) surgery. This cost-effective technique improves surgeon control and reduces cognitive workload in confined spaces.
Area of Science:
- Neurosurgery
- Surgical Innovation
- Minimally Invasive Procedures
Background:
- The endoscopic endonasal approach (EEA) has advanced significantly, yet challenges persist with specialized instrumentation, particularly for safe dural incision.
- Limited availability and ergonomics of dedicated tools hinder long-term use and reproducibility in EEA.
- Current methods for dural incision in EEA rely on instruments that are difficult to maintain and replace, impacting surgical workflow.
Purpose of the Study:
- To present a novel, reproducible technical modification for the dural incision phase of EEA.
- The modification aims to enhance safety, improve ergonomics, and increase the sustainability of surgical tools.
- Focus on refining the dural incision step for better outcomes in endoscopic skull base surgery.
Main Methods:
- A disposable microknife was adapted onto a reusable titanium handle.
- A standard suction catheter was modified to create a partially retractable protective sheath for the microknife.
- The technique was successfully applied in 30 consecutive endonasal surgeries for sellar and suprasellar lesions.
Main Results:
- The modified instrument integrated smoothly into the surgical workflow, allowing safe introduction and controlled blade exposure.
- The protective sheath minimized mucosal trauma during instrument manipulation while maintaining tactile feedback.
- Surgeons reported enhanced control, reduced cognitive load, and improved maneuverability, especially in challenging surgical corridors.
Conclusions:
- This technical adaptation offers a safe, ergonomic, and cost-effective solution for dural incision in EEA.
- The innovation aligns with incremental, experience-driven advancements in skull base surgery, fitting the IDEAL framework's Idea-Development stage.
- The refined technique improves practical aspects of EEA, contributing to safer and more efficient patient care.
