2005

ISSN 0042-8817

3

MAGAZINE

QUESTIONS OFNEUROSURGERYOf N.N. Burdenko

MOSCOW MEDICINE

PMID: 16485825 (PubMed - indexed for MEDLINE)

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EXPERIENCE IN USING A MOLECULAR RESONANCE COAGULATOR IN NEUROONCOLOGY

V.A. Cherekayev, A.Kh. Bekyashev, Yu. A. Filippov, A.I. Belov, D.A. Golbin

Abstract: The paper analyses the experience gained in using a molecular resonance coagulator in

145 patients with tumors of the base of the skull and brain.

The Vesalius NEUROsurgery N1 molecular resonance apparatus is an innovational bipolar devi-

ce that is specially designed for neurosurgical application (operations on brain).

Due to the fact that the temperature at the site of a cut does not exceed 45-50°C, the apparatus

has the minimum effect on tissues, nerves, nerve ending, and blood vessels, permitting a surge-

on to make interventions into sophisticated anatomic formations.

The apparatus operates in the modes “cut” and “coagulation” that enable operations to be perfor-

med on particularly minor and fine structures.

While working on brain tissues, it is particularly important that there is no thermal injury, tissue

charring, or sticking effect due to low working temperatures.

The possibility of concurrently making hemostasis and tissue dissection reduces the time of an

operation and considerably decreases the extent of blood loss.

The clinical case given in this paper demonstrates the universality of the Vesalius NEUROsurgery

N1 molecular resonance apparatus used in an infiltrative tumor of the bases of the skull.

One forceps operated in different modes may provide sparing coagulation of minor cortical arte-

ries, reduce the volume of a tumor through its bloodless dissection, arrest bleeding from the hype-

rostosis (wax sticking effect), prepare nerves in the upper lid slit and cavernous sinus.

The Vesalius NEUROsurgery N1 molecular resonance surgical apparatus is recommended for

neurosurgical care to perform brain operations requiring great caution in handling the tissues

being operated on.

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Electrosurgery is a branch of the surgery that usesa high frequency current (HFC) for the tissue dis-section and coagulation. The first experimentsusing HFC electrosurgery on humans, were done atthe end of the 19th Century, beginning of the 20thCentury. Electrosurgery is based fundamental phy-sical principle that thermal effect of the electriccurrent appears is strongest where the cross sectionof the conductor is minimal. In 1899, Oudin descri-bed tissue disintegration with high frequency cur-rent produced by sparkle generator. Since 1970HFC generators have obtained power levels whichallowed them to be used as a tool for electrosurge-ry. Electrosurgery method is based on the tissueheating and disintegration using the action of HFCwith temperatures above 100ºC. Haemostasis isalso developed based on thermal exposure andincludes as a matter of fact in bleeding surface cau-terization and thermo coagulation of minor bloodvessels. Usually electrosurgery apparatus works inthe frequency of 0.5-2 MHz and with a power rangefrom 300 to 700W.During the improvement of electrosurgery appara-tus, scientists determined that increasing of the fre-quency current would permit to increase the tissueheating velocity whilst at the same time reducingthe action time and heating zone. A new methodhas been named as radiofrequency surgery. Theapparatus for this technique works in a frequency ofup to 4 MHz on the power to several thousandwatts, however, this improvement was found unne-cessary. Radiofrequency surgery did not complete-ly abandon effect on the tissue at all, therefore the

zone of the thermal death of the cells in the sectionremains, although is decreased.

A new period of electrosurgery arrived with cur-rents making a molecular resonance in the tissue,when the high frequency oscillations of the cellsmembranes and cytoplasm lead to cell disintegra-tion without heating. Physics of this method can be explained by the fol-lowing: generated energy is transmitted by quan-tum. The energy which is exactly equal to the inter-molecular bonds’ energy. Molecular resonancegenerator works on the unique patent combinationof four frequencies in the range of 4 - 16 MHz,known as Cells Keeping Spectrum (CKS).Affecting on the bounds of the same energy, whichthey also have, generator’s quantum creates a reso-nance of the molecular bounds. In this case theamplitude of the oscillations of separated molecu-les rises immediately leading to the breakdown ofthe cell membrane. At the macroscopic level thiseffect is realized as tissue cut. The destruction ofintermolecular bounds occurs due to amplitudeincrease of their oscillations without bound energychanging.The action described above ensures that the tempe-rature at the zone of a cut does not exceed 45-50ºCreducing the zone of thermal necrosis to be formedand charring at the cut edges (see fig.1).The application of mechanical force to cut the tis-sue is not required thus As a result of this the shiftof individual layers of skin does not occur and hea-ling occurs quickly after initial closing without theformation of even the smallest scar.

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a b

c d

e f

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Advantages of the molecular-resonance surgerymethod:

1. Using molecular-resonance apparatus temperatu-re at the zone of a cut does not exceed 45-50ºC,which leads to- absence of thermal injury effect, tissue char-

ring, that almost exclude post-operated inflam-mation and reduce post-operation recoveryperiod more than twice;

- quite totally pain absence during the operation(nerve trunks and endings are not being inju-red) and the possibility to use only a local anae-sthetics in the post-operation period.

- the possibility to manipulate in the direct proxi-mity of blood vessels, nerve trunks and nerveendings.

2. Tissue dissection occurs without the applicationmechanical force, which helps the wound to healup by initial closing and without scar formation.

3. The possibility of concurrently making coagula-tion and tissue dissection minimises the extent ofblood loss: operation is performed in almost“dry” wound.

4. The availability of specialized generators enablesthe operation to be performed on various tissues,using a vantages of molecular resonance methodin several areas of medicine - neurosurgery, der-matology and plastic surgery, ENT- surgery,gynaecology, urology (also endoscopic).

The molecular resonance apparatus “VesaliusNEUROsurgery N1” is an evolutional bipolar devi-ce which is specifically designed for neurosurgicalapplication (operation on the brain). Due to the factthat the temperature at the site of the cut does notexceed 45-50°C, the apparatus has the minimumeffect on tissues, nerves, nerve ending, and bloodvessels, permitting a surgeon to make interventions

into sophisticated anatomic formations. The appa-ratus operates in the modes “cut” and “coagulation”that enables operations to be performed on particu-larly minor and delicate structures. While workingon brain tissues, it is particularly important thatthere is no thermal injury, tissue charring, or stic-king effect due to low working temperatures. Thepossibility of concurrently haemostasis and tissuedissection reduces the time of an operation andconsiderably decreases the extent of blood loss(Fig.2).

The apparatus was tested for sixth clinical depar-tment of N.N.Burdenko Neurosurgical Institute(NSI). Work of the apparatus “VesaliusNEUROsurgery N1” was tested on various modes(“cut” and “coagulation”) and power regimes. Thequality of tissue cutting by “cutting” forceps as wellas various diameter range blood vessels coagulationwas evaluated. The apparatus was used in neurosur-gical operations on 145 patients ranging in agefrom 15 - 69 years old at sixth clinical departmentof N.N.Burdenko Neurosurgical Institute (NSI).Majority of patients have had tumours of the baseof the skull (meningiomas of the wings of the mainbone, olfactory memingiomas, craniofacial tumors,VII nerve neurinomas). The apparatus was alsoused for removing parasiggital meningiomas, theglial brain tumors.

The apparatus proves to be reliable and effectivesurgical instrument, allowing making precisionneurosurgical operation. Particular attention shouldbe paid to gentle impact of the apparatus on dissec-ting and coagulating tissue. The apparatus is easy touse - it has convenient control panel to set up apower quickly and precisely. The apparatus is pro-vided with datasheet - in Russian - which containsexhaustive information about modes and full wor-king instructions, settings and safety measures

Fig.3. Molecular resonance apparatus "Vesalius NEUROsurgery N1" (a) in its accessories, pedal (b) and bipo-lar forceps (c).

ca

b

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necessary for using this instrument. “VesaliusNEUROsurgery N1” has a modern design, suitableand functional control panel (Fig.3, a). During thetesting period no issues with malfunctions, decrea-se of base bloc quality, connecting cables, footpedal and bipolar electrodes have been identified.Work elements of the apparatus (bipolar electrodes,connecting cables) could be sterilized using stan-dard protocols without additional treatment. One ofthe indisputable advantages is the absence of thescale on the tips of bipolar forceps during work A clinical observation, indicated below, shows thepossibilities of a molecular resonance coagulator inremoving of infiltrative meningiomas of the wingsof the main bone.

Molecular resonance surgery is a modern, high-performance surgical method to implement a widespectrum of the operations in many fields of surge-ry where care and precision are required when han-dling the tissues. It differs favourably from traditio-nal electrosurgery and laser surgery by the absenceof thermal injury of the operating tissue, lowersoreness, and minimal blood loss. Post-operatedinflammation is excluded completely; post-opera-tion recovery period is diminished essentially.Electrodes and other accessories of the apparatus“Vesalius NEUROsurgery N1” withstand steriliza-tion and can be used repeatedly.The Vesalius NEUROsurgery N1 molecular reso-nance surgical apparatus is recommended for neu-rosurgical care to perform brain operations requi-ring great caution in handling the tissues being ope-rated on.Patient 42 years old, case history N° 811/05, arri-ved in the institute with complaints on generalweakness, protrusion of left eyeball, periodical spe-ech disturbance. In 2002 she was operated in thehospital close to her residence. Meningiomas of thewings of the main bone of the left side was partial-ly removed. Half a year ago left-side exophthalmo-ses appeared and began to increase. During themedical examination signs of the initial growth ofthe meningiomas of the wings of the main bone onthe left side were recognized.During the period of recovery in neurological statuswas noted that there was hyperpathia of the left sideof her face, left-side exophthalmoses (2 mm) withoedema of eyelids.During magnetic resonance imaging (MRI) of thebrain infiltrative meningiomas of the wings of themain bone on the left side was recognized. (Fig.4,a).

During an operation it was revealed that there wasbleeding and moderate thickness hyperostosis ofthe wing of the main bone. During resection occursusing boron treatment and nippers, bleeding wasstopped by coagulation with “VesaliusNEUROsurgery N1” apparatus (Fig.5, g) (cuttingmode was 50-60 W). The thickness of the hypero-stosis projected in the upper lid slit reached 2 cm.The upper and the lower lid slit were opened afterremoving of hyperostosis. A big size infiltrativetumor of the bases of middle cranial fossa wasrevealed, expanding into the upper lid slit, caver-nous sinus and anterior clinoid process. The brainmembrane was cut. When the cystic cavity wasopened it was revealed that there were gross altera-tions of temporal lobe. Upper lateral parts of thetumor were a bottom of the cystic cavity. We beganwith coagulation by “Vesalius NEUROsurgery N1”of the points of tumors attachment to the bases ofmiddle cranial fossa. The tumor was compact,dense and moderately bleeding tumor. By reducingthe volume of the tumor with ultrasound aspiratorslowly also ultra lateral parts of the tumor wereremoved. The posterior region of the tumor hasspread to the cerebellar tentorium. After removalthe tumor from the cerebellar tentorium the basalregion was reduced with ultrasound aspirator. Thetumor was separated from cerebral cortex, as minorvessels extended from the tumor to internal capsu-le (Fig. 5, a ,b), from brain stem and branches of themiddle cerebral artery (coagulation mode 25 W),coagulates followed by dissection of middle area ofthe tumor (Fig. 5, b) (coagulation in the cuttingmode 50-60 W). Medial part has infiltrated theupper lid slit and has spread to cavernous sinus andanterior clinoid process. The tumor was separatedfrom middle part of the cavernous sinus. Outerdural leaflet of the roof of cavernous sinus wasinfiltrated. Infiltration has spread to frontal lobeand upper lid slit (Fig. 4, d) and this part of thetumor was removed. Infiltrated surface area wascoagulated. As volume of the tumor was reducedwith ultrasound aspirator the part of the tumorsituated on the anterior clinoid process was separa-ted from cerebral cortex and excised. Electrodeswere mounted on the levator muscle of upper eye-lid, and lateral rectus muscle. Under the stimulationcontrol infiltrative layer was diminished in the areaof the upper lid slit and frontal parts of the caver-nous sinus using coagulator “VesaliusNEUROsurgery N1” (coagulation mode 25-30 W)since oculomotor, trochlear and abducent nervesare responded (Fig. 5, e). Haemostasis and plastic

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repair of defects in the dura mater with piece ofperiosteum were carried out. The stitches weremade on the soft tissues. An active drain was orga-nized under the piece of periosteum. During the post-operated period the exophthalmoson the left side was regressed. At the time of thedischarge from hospital the patient had ptosis ofthe left eyelid and moderate limit of movement –in all directions – of the left eyeball. Brain compu-ter tomography (CT), using contrast dye, revealedliquid accumulation in the place where the tumorwas removed (Fig. 4, b). Histology diagnosis wasMeningotheliomatous meningiomas. Three weeksafter the operation ptosis had regressed complete-ly and left eyeball movement had totally recovered.

----------The clinical observation described above isdemonstrated universality of the coagulator“Vesalius NEUROsurgery N1” in case of infiltra-tive tumor of the bases of the skull. Operating bythe same coagulation forceps in different modesmay provide sparing coagulation of minor corticalarteries, reduce the volume of the tumor throughits bloodless dissection, arrest bleeding from thehyperostosis (wax sticking effect), and preparenerves in the upper lid slit and cavernous sinus.

Translated by Evgeniya Sharova, 2008

This a translation of the original article “EXPERIENCE INUSING A MOLECULAR RESONANCE COAGULATORIN NEUROONCOLOGY” from Magazine - Questions ofNeurosurgery, issn 0042-8817, PMID:16485825 (PubMed -indexed for MEDLINE)

Fig.4. Magnetic resonance and computer imaging of the patient before (a) and after (b) operation.

a

b

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