A Novel, Straightforward and Affordable Suction-Irrigation Device for Microneurosurgery: A Technical Note.

Abstract

Irrigation and suction devices are essential tools in microneurosurgery, allowing the maintenance of a clear operative field and meticulous dissection of critical neurovascular structures. Currently available suction-irrigation devices are in limited use due to their high price and difficulty of use in real-life situations. We present a novel suction-irrigation apparatus that is easy to utilize in every microneurosurgical operation and can be assembled with tools available in most neurosurgical centers. The irrigation device of a Medtronic irrigating drill is attached to a Fukushima suction tip with a small silicone band. Suction power is controlled by the surgeon's fingertip using a malleable suction tip, and irrigation is controlled using the drill's foot pedal. Narrated videos exemplifying the assembly and use of the suction-irrigation device were recorded. We have used the suction-irrigation device in 107 surgeries to date since its first application and have found it to enhance the operative experience as it provides optimal surgical visibility with reduced effort compared to traditional means. Adjuvant drugs such as nimodipine may be added to the irrigation fluid. The use of the suction-irrigation apparatus reduces the requirement of bipolar coagulation and improves operating comfort compared to a traditional stand-alone suction device and an assistant irrigating. We present the application of a cost-effective suction-irrigation technique that can be easily assembled from widely used traditional neurosurgical tools. The novel device enables minimally traumatic neurovascular microdissection even in the setting of subarachnoid hemorrhage and highly vascular tumors.