Collateral thermal injury during endoscopic skull base surgery from endonasal CO2 laser and coblation.

ABSTRACT

INTRODUCTION: Effective tissue removal techniques are essential in endoscopic skull base surgery. Improvements in technology permit more accurate application of CO2 laser and coblation during endonasal procedures. This study assessed the thermal injury patterns associated with fibre CO2 laser and coblation. METHODS: Fresh frozen cadaveric heads were used. Mucosal removal was performed at the ethmoid roof. Structured lesions were created using either CO2 laser or coblation. The corresponding thermal injury patterns on dural tissue were assessed and compared between the two groups. RESULTS: Five cadaveric heads were obtained; five sides received CO2 laser lesions and five coblation lesions. Forty per cent (n = two sides) of the CO2 specimens had macroscopic foci of grey-black discolouration on the dural aspect. No macroscopic dural changes were seen in the coblation specimens. CONCLUSION: Dural injury was seen following CO2 laser use despite attempts to avoid it. Both CO2 laser and coblation have their advantages; however, the lower thermal working power of coblation and superior depth control may make it more suitable for endoscopic endonasal periorbital and peridural surgery.