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Manual irrigation mitigates ultrasonic bone curette heat generation during optic nerve decompression: A cadaveric
Madeleine de Lotbiniere-Bassett1, Forrest Hamrick2, Rose Caston3
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA; Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada(2).
Background:
High-speed handheld drills are preferred for skull base bony decompressions despite potential risks to neurovascular structures posed by rotating shafts. Although ultrasonic bone curettes vibrate rather than rotate, previous work suggests they produce more heat than drills. The effect of room-temperature manual irrigation has not been studied. The authors examined the local thermal effects of a traditional high-speed drill and ultrasonic bone curette during optic nerve decompression.
Methods:
Optic canals were exposed bilaterally in five cadaveric specimens. Temperature probes were placed dorsal to the optic nerve within each canal. A handheld drill with a 4.0-mm diamond burr was used at 75,000 rotations per minute. The ultrasonic bone curette (Stryker Co., Kalamazoo, MI, USA) settings were 25 kHz and 290 µm amplitude on the contralateral canal, with 70% power considered "standard" and 100% "high." Specimens were exposed to several irrigation conditions: 1) no irrigation; 2) automatic device irrigation (40 mL/min curette, 12 mL/min drill); and 3) manual and device irrigation (curette only). The maximum difference between baseline and peak temperatures over 30 s of bony removal was recorded at each setting. Temperature was allowed to return to baseline between conditions.
Results:
Without irrigation, mean drill temperature changes were smaller (Δ7.1°C; 18.9°C-26.1°C]) than those with the curette (Δ12.4°C at 70%, Δ13.9°C at 100%). Using automatic device irrigation, mean drill temperature increases (Δ3.7°C) were also lower than with the curette (Δ9.0°C at 70%, Δ9.9°C at 100%), but adding room-temperature manual irrigation with device irrigation significantly cooled the curette (Δ3.3°C at 70%, Δ4.9°C at 100%).
Conclusions:
Room-temperature manual irrigation can offset the increased local temperature associated with ultrasonic bone curettes. With supplemental room-temperature manual irrigation, the bone curette produced a mean temperature rise of 3.3°C at 70% power and 4.9°C at 100%, and the device-irrigated drill produced a mean rise of 3.7°C.
