聴神経腫瘍手術における超音波凝固切開装置の応用

The Application of the Harmonic Scalpel in Acoustic Neuroma Surgery

　超音波凝固切開装置（ハーモニック　スカルペル）を後頭蓋窩に進展した聴神経腫瘍（AN）の減量に用い，有用であった．このシリーズでは主に拡大中頭蓋窩法II型〔中頭蓋窩経由迷路削開および上錐体静脈（SPS）離断，小脳天幕切開〕を聴力保存の適応のない例に用いた．ハーモニック　スカルペルのLaparosonic Coagulating Shears（LCS）をバイポーラの代わりにSPSの離断に用いた．LCSをバイポーラと比較すると，前2者がそれぞれ腫瘍の減量，SPSの離断の点において有用と思われた．

We have applied the Harmonic Scalpel (HS) in debulking the tumor in the posterior fossa and concluded that this is useful in acoustic neuroma surgery. In this series the extended middle cranial fossa approach type II (in which labyrinthectomy via the middle fossa and the separation of the superior petrosal sinus (SPS) and the incision of the cerebellar tentorium was done) was used mainly in cases in which hearing preserva-tion was not indicated. Laparosonic Coagulating Shears (LCS) was used for the separation of the SPS instead of a pair of bipolar forceps.