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Reaching the pituitary gland safely

Operations on the pituitary gland, an area located in the centre of the brain, are carried out minimally invasively, through the nasal cavity, as illustrated in Figure 1.

The first step to this procedure is to create an entry, where a layer of bone separates the nasal cavity from the brain. As part of this step, the skull base is shaved to a thin layer. The final pieces of the bone are removed with an instrument called surgical punch. This instrument is equipped with a straight, fixed shaft, and essentially chips away the bone, bite by bite. With every “bite”, the instrument has to be retracted and the bit of bone has to be removed from the tip of the instrument. This is cumbersome and adds unnecessary risk, as the surgery takes longer, and the risk of infection increases with every re-entry.

Additionally, the fixed shaft forces the surgeon to rotate the full instrument constantly, in order to align the tip with the bone. This causes collisions with the other instruments, like the endoscope.

Figure 1: An illustration of how the pituitary gland is reached through the nasal cavity [1]
Figure 1: An illustration of how the pituitary gland is reached through the nasal cavity [1]

Dr. van der Laan, UMCG,  Groningen, The Netherlands: 

“It will make it easier because we don’t have to use difficult position all the time to get to the area where we need to be.”

The innovation lies in the shaft of the instrument

Figure 2: Using the NeuroPunch during pituitary surgery
Figure 2: Using the NeuroPunch during pituitary surgery

The DEAM approach in this project resulted in the optimal combination of technical solutions as well as increased ergonomics and usability. The new system offers the opportunity to store the bits of excised bone inside the shaft, eliminating the need to remove the instrument from the nose for every bite. Additionally, it now incorporates a rotatable shaft, eliminating the need to move the full handle in order the align the shaft as desired. How to use the new design is illustrated in Figure 2.

Re-use the handle, secure sterility of the shaft

The NeuroPunch is a hybrid system; the shaft is disposable, so the bits of bone do not have to be removed after every use and sterility is guaranteed (Figure 3), whereas the handle is reusable, in order to decrease the medical waste produced during the procedure.

Figure 3: Storage container for bits of bone
Figure 3: Storage container for bits of bone

UMC Groningen and further research

The NeuroPunch was developed as part of a collaboration between DEAM and the ENT department of the University Hospital of Groningen (UMCG).

To further the obvious benefits of the NeuroPunch, new areas of application are being explored. This research has already suggested that spinal surgery, a procedure for which the same surgical punch is used, can also be an application of the NeuroPunch. More research will have to confirm this.

[1] PDQ Pediatric Treatment Editorial Board. Childhood Craniopharyngioma Treatment (PDQ®): Patient Version. 2021 Jan 6. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. [Figure, Transsphenoidal surgery. An endoscope and…] Available from: https://www.ncbi.nlm.nih.gov/books/NBK65796/figure/CDR0000574137__196/

October 30, 2020