Use of the ultrasonically activated scalpel in acoustic neuroma surgery: Preliminary report

Recently, the ultrasonic activated scalpel (the Harmonic Scalpel, HS) has b een introduced in laparoscopic surgery. We have applied the HS in debulking the tumor in the posterior fossa and concluded that this is useful in acou stic neuroma surgery. Fifteen patients with a tumor extending more than 20 mm into the posterior fossa were included in this study. The extended middl e cranial fossa approach type II was used in 13 patients and type III (hear ing preservation surgery) was used in 2 patients. In one of two patients, h earing was preserved. Postoperative facial nerve function according to the House-Brackmann method was grade I in 12 patients, grade II in 2 patients, and grade III in 1 patient. Comparing the technique of using HS to a pair o f bipolar forceps and/or ultrasonic cavitational aspirator, the former can result in better preservation of the facial nerve function.