CAVALLO/CAPPABIANCA Set

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1 NEURO /2014-E CAVALLO/CAPPABIANCA Set for Endoscopic Endonasal Skull Base Surgery

2 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 Naples, Italy

3 2 3 A B C D 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 A C B 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

4 A B 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: precommunicating 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 C D 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 micro-dissector (A) and micrograsping 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

5 4 5 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 A B 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 A B 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

6 Endoscopic Endonasal Skull Base Surgery Recommended Set by CAVALLO/CAPPABIANCA

7 6 7 Recommended Set by CAVALLO/CAPPABIANCA XA Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, 8 Fr., working length 15 cm XB Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, 6 Fr., working length 15 cm 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 XD Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, malleable, 8 Fr., working length 15 cm XE Suction Tube, with cut-off hole, drop-shaped, with distance markings, LUER, conical distal end, malleable, 6 Fr., working length 15 cm SAD Scissors, curved upwards 45, delicate, sheath 360 rotatable, working length 18 cm TA Forceps, very delicate, oval cupped jaws 0.9 mm, curved upwards, working length 18 cm TD Forceps, round cupped jaws, diameter 0.6 mm, extra delicate, straight, working length 18 cm GF Miniature Grasping Forceps, serrated, straight, working length 18 cm GU Minature Forceps, through-cutting, with fine flat jaws, bite 1 mm, curved upwards, working length 18 cm GS Minature Forceps, through-cutting, with fine flat jaws, bite 1 mm, straight, working length 18 cm Miniature Forceps, curved upwards, through-cutting, with fine, flat jaws, width of cut 1 mm, working length 15 cm

8 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 H CASTELNUOVO Hook, 90, blunt, with round handle, length 25 cm HA Seeker, angled 45, with ball end, diameter 1 mm, length 25 cm HB Seeker, 90, with ball end, diameter 0.4 mm, length 25 cm HC Seeker, 90, with ball end, diameter 0.4 mm, length 25 cm DS Dissector, sharp, tip angled 15, slightly curved spatula, with round handle, size 2 mm, length 25 cm DT Dissector, sharp, slightly curved spatula, tip angled 15, size 1 mm, with round handle, length 25 cm ELS Micro Raspatory, single curved to left, width 2 mm, length 25 cm ERS Micro Raspatory, single curved to right, width 2 mm, length 25 cm RN CAPPABIANCA-de DIVITIIS Ring Curette, round wire, inner diameter 3 mm, tip angled 45, with round handle, length 25 cm RV CAPPABIANCA-de DIVITIIS Ring-Curette, round wire, inner diameter 3 mm, tip laterally angled 90, with round handle, length 25 cm KB Curette, round spoon, tip slightly angled, size 2 mm, with round handle, length 25 cm KC Curette, round spoon, tip slightly angled, size 3 mm, with round handle, length 23 cm

9 M de DIVITIIS-CAPPABIANCA Scalpel, with retractable blade, length 23 cm Handle Micro Knife, pointed KK de DIVITIIS-CAPPABIANCA Scalpel, with retractable blade, length 23 cm Handle Micro Knife, sickle-shaped PBA Micro Forceps, bayonet-shaped, smooth, 0.5 mm, working length 10 cm PBB Micro Forceps, bayonet-shaped, spoon, 2 mm, working length 10 cm PBE Micro Forceps, bayonet shaped, spoon, 4 mm, working length 10 cm SBA Micro Scissors, bayonet-shaped, sharp/sharp, straight, working length 10 cm SBB Micro Scissors, bayonet-shaped, sharp/sharp, curved to left, working length 10 cm SBD Micro Scissors, bayonet shaped, sharp/sharp, curved to right, working length 10 cm

10 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.

11 10 11 Optional Telescopes and Instruments AA HOPKINS Straight Forward Telescope 0º, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: green BA HOPKINS Forward-Oblique Telescope 30º, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: red FA HOPKINS Forward-Oblique Telescope 45º, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: black AA HOPKINS Straight Forward Telescope 0º, enlarged view, diameter 4 mm, length 30 cm, autoclavable, fiber optic light transmission incorporated, color code: green MI Lesion Meter, to determine the size of transnasal lesions, with wheel handle and scale, width 2 mm, working length 19 cm

12 28164 BDB TAKE-APART Bipolar Forceps, short, rounded tip, width 2 mm, outer diameter 3.4 mm, working length 14 cm Bipolar Ring Handle Inner Sheath Forceps Insert BDC TAKE-APART Bipolar Forceps, short, pointed tip, width 2 mm, outer diameter 3.4 mm, working length 14 cm Bipolar Ring Handle Inner Sheath Forceps Insert BDL TAKE-APART Bipolar Forceps, delicate jaws, width 1 mm, distally angled 45, vertical closing, outer diameter 3.4 mm, working length 20 cm Bipolar Ring Handle Inner Sheath Forceps Insert BDM TAKE-APART Bipolar Forceps, delicate jaws, width 1 mm, distally angled 45, horizontal closing, outer diameter 3.4 mm, working length 20 cm Bipolar Ring Handle Inner Sheath Forceps Insert

13 BDD TAKE-APART Bipolar Forceps, width 2 mm, distally angled 45, horizontal closing, outer diameter 3.4 mm, working length 20 cm Bipolar Ring Handle Inner Sheath Forceps Insert BDK TAKE-APART Bipolar Forceps, width 4 mm, distally angled 45, horizontal closing, outer diameter 3.4 mm, working length 20 cm Bipolar Ring Handle Inner Sheath Forceps Insert BDG TAKE-APART TAN Bipolar Grasping Forceps, size 3.4 mm, working length 20 cm Bipolar Ring Handle Inner Sheath Forceps Insert L Bipolar High Frequency Cord, with 2x 4 mm banana plug for KARL STORZ Coagulator XA/XB and Ellman coagulators, length 300 cm LA Bipolar High Frequency Cord, with 2x 4 mm banana plug for KARL STORZ Coagulator XA/XB and Valleylab coagulators, length 300 cm 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 B/C/D, B/C/D, B/C/D, B/C/D, AUTOCON series (50, 200, 350) and Erbe coagulators, T and ICC series, length 300 cm LM Bipolar High Frequency Cord, for Martin and Berchthold coagualtors, length 300 cm LV Bipolar High Frequency Cord, for KARL STORZ AUTOCON II 400 SCB system (112, 114, 116, 122, 125) and Valleylab coagulators, length 300 cm

14 UNIDRIVE S III NEURO SCB Two-Pedal Footswitch Silicone Tubing Set U N I T S I D E P A T I E N T S I D E High-Speed Micro-Motor High-Performance EC Micro-Motor II DRILLCUT-X II Shaver Handpiece STAMMBERGER-CASTELNUOVO DRILLCUT-X Shaver Handpiece Perforator INTRA Drill Handpieces, 80,000 rpm Craniotome INTRA Drill Handpieces, 40,000 rpm , High-Speed Handpieces, 100,000 rpm Intranasal Drill High-Speed Handpieces, 60,000 rpm Dermatomes , , Micro Saw

15 14 15 UNIDRIVE S III NEURO SCB 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 VAC, 50/60 Hz 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 Specifications: Touch Screen 6.4"/300 cd/m 2 Dimensions w x h x d 300 x 165 x 265 mm Available languages English, French, German, Weight 5.2 kg Spanish, Italian, Portuguese, Greek, Turkish, Polish, Russian Power supply VAC, 50/60 Hz Certified to: IEC 601-1, CE acc. to MDD * mtp medical technical promotion gmbh, Take-Off GewerbePark 46, Neuhausen ob Eck/Germany, Tel.: +49 (0) , Fax: +49 (0) , It is recommended to check the suitability of the product for the intended procedure prior to use NEURO /2014/EW-E Consent to receive electronic information q Yes, I agree to receive future information by at the following address: Department / Practice ZIP, Town Name Street address 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 ing KARL STORZ at KARL STORZ will not make these data available to third parties.

16 KARL STORZ GmbH & Co. KG Mittelstraße 8, Tuttlingen, Germany Postbox 230, Tuttlingen, Germany Phone: +49 (0) Fax: +49 (0) KARL STORZ Endoscopy-America, Inc East Grand Avenue El Segundo, CA , USA Phone: Phone toll free: (US only) Fax: Fax toll free: (US only) NEURO /2014/EW-E

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