コロラドマイクロディセクションニードルの使用経験

Clinical Application of the Colorado-microdissection Needle in Neurosurgery

Ⅰ．はじめに

　脳神経外科手術において，頭皮切開にはメスおよび頭皮クリップを用いることが一般的である．これまで電気メスは主に皮下や深部組織に使われ，表皮の切開に対しては創の治癒遅延や感染への恐れから敬遠されてきた．今回われわれは，頭皮切開にコロラドマイクロディセクションニードル（Stryker Co., Ltd.）を用い，その有用性を報告する．

　The steel scalpel and scalp clips have been commonly used for scalp incision in many neurosurgical procedures. Electrocautery is used mainly for subcutaneous and deep-layer dissection. The use of electrocautery on scalp incision has been avoided because of possible adverse events such as wound dehiscence and infection. We report our experience in Colorado-microdissection needle electrocautery for scalp incisions performed in our institution between November,2006 and March,2009. The rate of wound infection was compared in patients using the microdissection needle (100 procedures,n=93) and those using the steel scalpel/clips (n=261) during the same period. In patients using the microdissection needle,wound healing delay was not observed. Wound infection developed in only one procedure (1.0%) with the microdissection needle,and it developed in 6 procedures (2.2%) with the steel scalpel/clips,although this did not reach statistical significance (p=0.34). The use of electrocautery tended to cause little tissue distortion during fine dissection and it reduced blood loss. In conclusion,Colorado-microdissection needle electrocautery for scalp incisions could be safe and quite useful in neurosurgical procedures.