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Technical report
peer-reviewed

The Xomed Monopolar Cranial Nerve Stimulator Electrode: A Surprising Handy Tool for Deep Dissection of Epidermoid Tumors



Abstract

Epidermoid cysts are notorious for their propensity to sneak into deep recesses between cranial nerves in the posterior fossa. Attempts to achieve complete excision using ordinary instruments when tempted by the seeming ease of dissection is known to cause unacceptable deficits. The Xomed monopolar stimulator electrode probe of the nerve integrity electromyography monitor has several advantages when used as the primary dissection tool for deep-seated epidermoid cysts. Cerebellopontine angle epidermoid is the classical prototype of a strategically placed deep-seated epidermoid tumor.

The author describes the use of the monopolar stimulator electrode of the nerve integrity electromyography monitor as the primary dissection tool for excising epidermoid cysts of the cerebellopontine angle. Thin profile, rounded nontraumatic tip, and springiness of the body of the monopolar electrode aid the dissection.

The monopolar electrode was used to tease and scoop out the flakes aided by a fine suction. An initial internal decompression allowed the capsule to be folded away and separated from neurovascular structures using the dissector. The thin profile of both the instruments allowed good visualization and delicate control over the dissection in depths of the resection cavity without undue traction or impacts on superficially dissected cranial nerves. This novel use of the monopolar electrode was employed in the surgical excision of epidermoid cysts of the cerebellopontine angle in nine patients.

Total or near total excision was possible in eight of the nine patients who underwent excision using this technique. In three patients, mild deficits primarily of the fifth nerve sensory function were noted.

The Xomed monopolar stimulating electrode of the nerve integrity electromyography monitor is an ideal instrument for deep dissection of epidermoid cysts in areas where neurovascular structures are at risk.



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Technical report
peer-reviewed

The Xomed Monopolar Cranial Nerve Stimulator Electrode: A Surprising Handy Tool for Deep Dissection of Epidermoid Tumors


Author Information

Gopalakrishnan M. Sasidharan Corresponding Author

Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Technical report
peer-reviewed

The Xomed Monopolar Cranial Nerve Stimulator Electrode: A Surprising Handy Tool for Deep Dissection of Epidermoid Tumors


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Technical report
peer-reviewed

The Xomed Monopolar Cranial Nerve Stimulator Electrode: A Surprising Handy Tool for Deep Dissection of Epidermoid Tumors

  • Author Information
    Gopalakrishnan M. Sasidharan Corresponding Author

    Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 12, 2018

    DOI

    10.7759/cureus.2058

    Cite this article as:

    Sasidharan G M (January 12, 2018) The Xomed Monopolar Cranial Nerve Stimulator Electrode: A Surprising Handy Tool for Deep Dissection of Epidermoid Tumors. Cureus 10(1): e2058. doi:10.7759/cureus.2058

    Publication history

    Received by Cureus: December 23, 2017
    Peer review began: January 01, 2018
    Peer review concluded: January 10, 2018
    Published: January 12, 2018

    Copyright

    © Copyright 2018
    Sasidharan. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Epidermoid cysts are notorious for their propensity to sneak into deep recesses between cranial nerves in the posterior fossa. Attempts to achieve complete excision using ordinary instruments when tempted by the seeming ease of dissection is known to cause unacceptable deficits. The Xomed monopolar stimulator electrode probe of the nerve integrity electromyography monitor has several advantages when used as the primary dissection tool for deep-seated epidermoid cysts. Cerebellopontine angle epidermoid is the classical prototype of a strategically placed deep-seated epidermoid tumor.

The author describes the use of the monopolar stimulator electrode of the nerve integrity electromyography monitor as the primary dissection tool for excising epidermoid cysts of the cerebellopontine angle. Thin profile, rounded nontraumatic tip, and springiness of the body of the monopolar electrode aid the dissection.

The monopolar electrode was used to tease and scoop out the flakes aided by a fine suction. An initial internal decompression allowed the capsule to be folded away and separated from neurovascular structures using the dissector. The thin profile of both the instruments allowed good visualization and delicate control over the dissection in depths of the resection cavity without undue traction or impacts on superficially dissected cranial nerves. This novel use of the monopolar electrode was employed in the surgical excision of epidermoid cysts of the cerebellopontine angle in nine patients.

Total or near total excision was possible in eight of the nine patients who underwent excision using this technique. In three patients, mild deficits primarily of the fifth nerve sensory function were noted.

The Xomed monopolar stimulating electrode of the nerve integrity electromyography monitor is an ideal instrument for deep dissection of epidermoid cysts in areas where neurovascular structures are at risk.



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Create a free account to continue reading this article.

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Gopalakrishnan M. Sasidharan

Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

For correspondence:
gopalakrishnanms@gmail.com

Gopalakrishnan M. Sasidharan

Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

For correspondence:
gopalakrishnanms@gmail.com