CAVALLO/CAPPABIANCA Set

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CAVALLO/CAPPABIANCA Set

for Endoscopic Endonasal Skull Base Surgery

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The success of a surgical technique strictly relies on the in-depth knowledge of the surgical

anatomy, the achievement of a mutual multidisciplinary expertise and, nonetheless, on the

availability of dedicated instruments and tools. Advances in surgical instrumentation, hemostatic

techniques and materials, image guidance systems, and, most importantly, close cooperation

among different specialists, have recently resulted in tremendous changes in the practice of skull

base surgery, ultimately resulting in a movement toward less invasive procedures.

In recent years, the endoscopic endonasal approaches to the skull base have developed, perfectly

suiting this environment of evolving ideas and technological progress. Nowadays, it represents a

minimally invasive approach dealing with several diseases concerning mostly the entire skull base

- namely the suprasellar, retrosellar and parasellar spaces – obviating brain retraction and nerve

manipulation.

Nevertheless, the introduction of a novel surgical approach or technique requires the design and

refinement of new dedicated instruments and tools, so that surgeons also need to acquire mastery

of pros and cons of all the materials and instruments to be used during the operation. Indeed, the

endoscopic endonasal technique responds to very different principles involved in handling and

using the instruments.

We recommend the use of a specifically tailored set of instruments for endoscopic endonasal skull

base surgery: this instrument set has been specifically designed and collected to reproduce the

same bimanual microsurgical deeds as for transcranial procedures.

Malleable suction tubes, with angled tips and with marks along the shaft and several dissectors

and elevators, blunt and sharp, with round and/or straight tip, with different angles of the shaft

are included. A complete set of microscissors with straight and angled tips are required to ease

the sharp dissection and cutting maneuvers. A selection of dissection and grasping forceps with

a variety of jaw sizes is available; they are made with a definite handle area with which to properly

use the instrument and control the opening and closing action of the tips.

These features allow the constant control of the instrument tip under endoscopic view, the ability

to reach the hidden corners, and increase the depth perception and accuracy of definition of

distance and relationships between the main intradural neurovascular structures.

Luigi Maria CAVALLO, M.D., Ph.D.

Paolo CAPPABIANCA, M.D.

Department of Neurological Sciences, Division of Neurosurgery

Università degli Studi di Napoli Federico II

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Fig. 1:

Intraoperative picture showing endoscopic

endonasal approach for the removal of an olfactory groove

meningioma.

A:

close-up view during dissection of tumor

capsule from the left olfactory nerve means of a hockey

stick and blunt curved suction tube.

B:

dissection of the

arachnoid from a branch of left fronto-polar artery with a

blunt hook.

C:

dissection of the same vessel using curved

bayonet-shaped micro scissors.

D:

endoscopic view of

surgical cavity after tumor removal.

*:

olfactory nerve

Fig. 2:

Intraoperative picture showing endoscopic

endonasal approach for the removal of a dumb-bell

shaped intra-suprasellar pituitary macroadenoma.

A:

removal of the supradiaphragmatic portion of the tumor

using a curved suction tube.

B:

exploration of the

interpeduncular cistern using a 1 mm diameter suction

tube.

C:

panoramic view after tumor removal.

MB:

mammillary bodies;

Ch:

chiasm;

T:

Tumor;

*: anterior communicating artery

A

B

C

D

A

B

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Fig. 4:

Intraoperative picture showing endoscopic

endonasal approach for the removal of an infundibular

craniopharyngioma.

A and B:

bimanual tumor dissection

and removal using a dissector (A) and

micro-grasping forceps (B) with the pulling action of the suction

tube.

C:

hemostasis of the surgical field using

TAKE-APART

®

bipolar forceps.

D:

after tumor removal the

endoscopic exploration allows visualization of the third

ventricle cavity.

MB:

mammillary bodies;

Ch:

chiasm

Fig. 3:

Intraoperative picture showing endoscopic endonasal approach for the removal of

a tuberculum sellae meningioma.

A:

arachnoid dissection of the tumor capsule from the

ACoA complex with a blunt hook while tumor is pulled gently away by means of a curved

suction tube.

B:

panoramic view after tumor removal.

HA:

Recurrent Artery of Heubner;

ACoA:

anterior communicating artery;

A1:

pre-communicating tract of the anterior cerebral artery;

A2:

post-communicating tract of the

anterior cerebral artery;

T:

tumor; Ch: chiasm;

ON:

optic nerve;

Ps:

pituitary stalk

A

B

A

B

C

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Fig. 6:

Intraoperative picture showing the measurement of the osteo-dural defect.

A and B:

after intra-dural injection of fibrin glue, the size of the osteo-dural defect

is defined using a new measurement instrument

Fig. 7:

Intraoperative picture showing the reconstruction of the osteo-dural defect.

A and B:

a sheet of resorbable solid material, previously tailored with the measurement

instrument, is placed over the dural substitute and embedded in the extradural space,

dragging the dural substitute into overlay position using a 45° ring curette and suction tube.

*:

bone substitute (Lactosorb

®

);

DS:

dural substitute

A

B

A

B

Fig. 5:

Intraoperative picture showing endoscopic endonasal approach for the removal

of a suprasellar Rathke’s cleft cyst.

A:

panoramic view showing aspiration of the cyst

content, using a suction tube with distance markers.

B:

close-up view of the suprasellar

subchiasmatic area during tumor capsule fenestration maneuvers.

Pg:

pituitary gland;

*:

colloid cyst content;

Ps:

pituitary stalk;

Ch:

optic chiasm

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Endoscopic Endonasal Skull Base Surgery

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Recommended Set by

CAVALLO/CAPPABIANCA

28164 XA Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, 8 Fr., working length 15 cm

28164 XB Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, 6 Fr., working length 15 cm

28164 XC Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, tip curved upwards, ball end, 2.4 mm, working length 15 cm

28164 XD Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, malleable, 8 Fr., working length 15 cm

28164 XE Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, malleable, 6 Fr., working length 15 cm

28164 SAD Scissors, curved upwards 45°, delicate, sheath 360° rotatable, working length 18 cm

28164 TA Forceps, very delicate, oval cupped jaws 0.9 mm, curved upwards, working length 18 cm

28164 TD Forceps, round cupped jaws, diameter

0.6 mm, extra delicate, straight, working length 18 cm 28164 GF Miniature Grasping Forceps, serrated, straight,

working length 18 cm

28164 GU Minature Forceps, through-cutting, with fine flat jaws, bite 1 mm, curved upwards, working length 18 cm 28164 GS Minature Forceps, through-cutting, with fine flat jaws,

bite 1 mm, straight, working length 18 cm

662257 Miniature Forceps, curved upwards, through-cutting, with fine, flat jaws, width of cut 1 mm, working length 15 cm

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452833 RHINOFORCE®_{II Miniature Nasal Forceps,} with extra fine, flat jaws, through-cutting, for tissue-sparing, sheath curved 30°, straight jaws, width of cut 1.5 mm, with cleaning connector, working length 13 cm

28164 H CASTELNUOVO Hook, 90°, blunt, with round handle, length 25 cm

28164 HA Seeker, angled 45°, with ball end, diameter 1 mm, length 25 cm 28164 HB Seeker, 90°, with ball end, diameter 0.4 mm, length 25 cm 28164 HC Seeker, 90°, with ball end, diameter 0.4 mm, length 25 cm 28164 DS Dissector, sharp, tip angled 15°, slightly curved spatula,

with round handle, size 2 mm, length 25 cm

28164 DT Dissector, sharp, slightly curved spatula, tip angled 15°, size 1 mm, with round handle, length 25 cm

28164 ELS Micro Raspatory, single curved to left, width 2 mm, length 25 cm 28164 ERS Micro Raspatory, single curved to right, width 2 mm, length 25 cm

28164 RN CAPPABIANCA-de DIVITIIS Ring Curette, round wire, inner diameter 3 mm, tip angled 45°, with round handle, length 25 cm 28164 RV CAPPABIANCA-de DIVITIIS Ring-Curette, round wire, inner

diameter 3 mm, tip laterally angled 90°, with round handle, length 25 cm

28164 KB Curette, round spoon, tip slightly angled, size 2 mm, with round handle, length 25 cm

28164 KC Curette, round spoon, tip slightly angled, size 3 mm, with round handle, length 23 cm

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28164 M de DIVITIIS-CAPPABIANCA Scalpel, with retractable blade,

length 23 cm

including:

Handle

Outer Sheath

Micro Knife, pointed

28164 KK de DIVITIIS-CAPPABIANCA Scalpel, with retractable blade,

length 23 cm

including:

Handle

Outer Sheath

Micro Knife, sickle-shaped

28164 PBA Micro Forceps, bayonet-shaped, smooth, 0.5 mm,

28164 PBB Micro Forceps, bayonet-shaped, spoon, 2 mm,

28164 PBE Micro Forceps, bayonet shaped, spoon, 4 mm,

28164 SBA Micro Scissors, bayonet-shaped, sharp/sharp, straight,

28164 SBB Micro Scissors, bayonet-shaped, sharp/sharp, curved to left,

28164 SBD Micro Scissors, bayonet shaped, sharp/sharp, curved to right,

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39260 JC Container for Sterilization and Storage, of one CAVALLO/CAPPABIANCA Set for Endoscopic Endonasal Skull Base Surgery, external dimensions

(w x d x h): 527 x 252 x 187 mm

A container for sterilization and storage was especially designed for the

CAVALLO/CAPPABIANCA set to provide clear and simple storage. Product numbers are

inscribed on the Inlays so that these can be removed separately. The required instruments

are, therefore, clearly arranged for use in the OR.

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Optional Telescopes and Instruments

28132 AA HOPKINS®_{Straight Forward Telescope 0º,} enlarged view, diameter 4 mm, length 18 cm,

autoclavable, fiber optic light transmission incorporated, color code: green

28132 BA HOPKINS®_{Forward-Oblique Telescope 30º,} enlarged view, diameter 4 mm, length 18 cm,

autoclavable, fiber optic light transmission incorporated, color code: red

28132 FA HOPKINS®_{Forward-Oblique Telescope 45º,} enlarged view, diameter 4 mm, length 18 cm,

autoclavable, fiber optic light transmission incorporated, color code: black

28164 AA HOPKINS®_{Straight Forward Telescope 0º,} enlarged view, diameter 4 mm, length 30 cm,

autoclavable, fiber optic light transmission incorporated, color code: green

28164 MI Lesion Meter, to determine the size of transnasal lesions, with wheel handle and scale, width 2 mm, working length 19 cm

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28164 BDB TAKE-APART®_{Bipolar Forceps,} short, rounded tip, width 2 mm, outer diameter 3.4 mm, working length 14 cm including:

Bipolar Ring Handle Outer Sheath Inner Sheath Forceps Insert

28164 BDC TAKE-APART®_{Bipolar Forceps,} short, pointed tip, width 2 mm, outer diameter 3.4 mm, working length 14 cm including:

Bipolar Ring Handle Outer Sheath Inner Sheath Forceps Insert

28164 BDL TAKE-APART®_{Bipolar Forceps,} delicate jaws, width 1 mm,

distally angled 45°, vertical closing,

outer diameter 3.4 mm, working length 20 cm including:

Bipolar Ring Handle Outer Sheath Inner Sheath Forceps Insert

28164 BDM TAKE-APART®_{Bipolar Forceps,} delicate jaws, width 1 mm,

distally angled 45°, horizontal closing, outer diameter 3.4 mm, working length 20 cm including:

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28164 BDD TAKE-APART®_{Bipolar Forceps,} width 2 mm, distally angled 45°,

horizontal closing, outer diameter 3.4 mm, working length 20 cm

including:

Bipolar Ring Handle Outer Sheath Inner Sheath Forceps Insert

28164 BDK TAKE-APART®_{Bipolar Forceps,} width 4 mm, distally angled 45°,

horizontal closing, outer diameter 3.4 mm, working length 20 cm

including:

28164 BDG TAKE-APART®_TAN_{Bipolar Grasping Forceps,} size 3.4 mm, working length 20 cm

including:

Bipolar Ring Handle Outer Sheath Inner Sheath Forceps Insert

26176 L Bipolar High Frequency Cord, with 2x 4 mm banana plug for KARL STORZ Coagulator 26020 XA/XB and Ellman coagulators, length 300 cm

26176 LA Bipolar High Frequency Cord, with 2x 4 mm banana plug for KARL STORZ Coagulator 26020 XA/XB and Valleylab coagulators, length 300 cm

26176 LE Bipolar High Frequency Cord, for AUTOCON® _{II 400 SCB system} (111, 113, 115, 122, 125), AUTOCON®_{II 200, AUTOCON}®_{II 80,} KARL STORZ Coagulator 26021 B/C/D, 860021 B/C/D, 27810 B/C/D, 28810 B/C/D, AUTOCON®_{series (50, 200, 350) and Erbe coagulators,} T and ICC series, length 300 cm

26176 LM Bipolar High Frequency Cord, for Martin and Berchthold coagualtors, length 300 cm

26176 LV Bipolar High Frequency Cord, for KARL STORZ AUTOCON® _{II 400 SCB} system (112, 114, 116, 122, 125) and Valleylab coagulators, length 300 cm

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UNIDRIVE

®

S III NEURO SCB

STAMMBERGER-CASTELNUOVO

DRILLCUT-X®_{Shaver Handpiece}

407110 50

207116 40

Silicone Tubing Set

U N I T S I D E

P A T I E N T S I D E

INTRA Drill Handpieces,

80,000 rpm

660000

INTRA Drill Handpieces,

40,000 rpm 252640 252573 – 252575 252645 252570 – 252572, 252590 – 252592 Perforator Craniotome 252680 – 252682 High-Speed Handpieces, 100,000 rpm 252660 – 252663, 252690 – 252692, 252671 – 252672 High-Speed Handpieces, 60,000 rpm Intranasal Drill Dermatomes 254000 253000 – 253300 Micro Saw 200166 30

DRILLCUT-X®_{II Shaver Handpiece}

407120 50 407120 55 High-Performance EC Micro-Motor II 207110 33 207111 73 High-Speed Micro-Motor 207120 33 Two-Pedal Footswitch

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40 7017 01-1 UNIDRIVE®_S_{III NEURO SCB,}_{motor control unit with color display,} touch screen, two motor outputs, integrated irrigation pump and integrated SCB module, power supply 100-240 VAC, 50/60 Hz including:

Mains Cord Irrigator Rod

Two-Pedal Footswitch, two-stage, with proportional function

Silicone Tubing Set, for irrigation, sterilizable

Clip Set, for use with tubing set

SCB Connecting Cable, length 100 cm

Single Use Tubing Set*, sterile, package of 3

mtp medical technical promotion gmbh, Take-Off GewerbePark 46,

78579 Neuhausen ob Eck/Germany, Tel.: +49 (0) 7467 94504-0, Fax: +49 (0) 7467 9450499, E-Mail: [email protected], www.mtp-tut.com

UNIDRIVE

®

S III NEURO SCB

Specifications:

Touch Screen 6.4"/300 cd/m2 _{Dimensions w x h x d} _{300 x 165 x 265 mm}

Available languages English, French, German, Spanish, Italian, Portu-guese, Greek, Turkish, Polish, Russian

Weight 5.2 kg

Power supply 100-240 VAC, 50/60 Hz Certified to: IEC 601-1, CE acc. to

MDD

Consent to receive electronic information

q

Yes, I agree to receive future information by email at the following address:

Email Name

Department / Practice Street address

ZIP, Town Signature

I agree to my data being stored at KARL STORZ for this purpose. I can withdraw my consent at any time and without giving reasons by emailing KARL STORZ at [email protected]. KARL STORZ will not make these data available to third parties.

*

It is recommended to check the suitability of the product for the intended procedure prior to use.

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96022025 NEURO 25-2 07/2014/EW-E

KARL STORZ GmbH & Co. KG

Mittelstraße 8, 78532 Tuttlingen, Germany Postbox 230, 78503 Tuttlingen, Germany Phone: +49 (0)7461 708-0

Fax: +49 (0)7461 708-105 E-Mail: [email protected] www.karlstorz.com

KARL STORZ Endoscopy-America, Inc.

2151 East Grand Avenue

El Segundo, CA 90245-5017, USA Phone: +1 424 218-8100 Phone toll free: 800 421-0837 (US only) Fax: +1 424 218-8525 Fax toll free: 800 321-1304 (US only) E-Mail: [email protected]