Utilization of the Cavitron Ultrasound Surgical Aspiration System in Resective Epilepsy Surgery

Abstract

Objective

This study aimed to systematically evaluate the application of the Cavitron Ultrasonic Surgical Aspirator (CUSA) system in epilepsy surgery and summarize associated surgical experiences.

Methods

In this retrospective analysis, 70 patients with refractory epilepsy underwent CUSA-assisted resection, while 20 controls underwent conventional surgical resection. Patients were categorized according to surgical scenarios for CUSA application, including lesion-related epilepsy resections, mesial temporal lobe procedures, neocortical resections within eloquent areas, and cases requiring preservation of critical vascular structures. Detailed operative metrics were analyzed for each category. Comparative assessments between the CUSA and conventional groups included surgical efficiency, complication rates, and postoperative seizure outcomes on the basis of the modified Engel classification.

Results

CUSA was used for the following procedures: resection of epileptic lesions (n = 26), mesial temporal structures (n = 32), the epileptogenic neocortex (n = 28), and the rolandic cortex (n = 17). Additionally, it was utilized in 6 cases requiring vascular protection during insular resection and in 18 cases involving preservation of cortical dangerous veins. Although the overall surgical efficiency was comparable between the CUSA and conventional groups (68.0 ± 18.2 vs. 61.1 ± 14.7 min, P = 0.180), the CUSA group demonstrated superior efficiency in resecting low-grade tumors (58.6 ± 14.9 vs. 68.1 ± 11.2 min, P = 0.034). Furthermore, the CUSA group presented significantly fewer permanent complications (5.7% vs. 10%, P < 0.0001) and a higher rate of Engel Class I outcomes (82.9% vs. 70.0%, P = 0.278).

Conclusions

The CUSA system represents a suitable and promising surgical tool for resective epilepsy surgery, potentially serving as a valuable option for epilepsy surgeons. Further studies are warranted to validate these findings.

Keywords

Epilepsy surgery / Cavitron ultrasound surgical aspirator (CUSA) / Resection / Refractory epilepsy / Ultrasonic aspirator

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Funding

Featured Clinical Technique of Guangzhou(2023P-TS09)

RIGHTS & PERMISSIONS

The Author(s), under exclusive licence to the Huazhong University of Science and Technology