gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

Article

Send article

Safety and usefulness of two different flexible hand-held laser fibers in microsurgical removal of acoustic neuromas

Meeting Abstract

Search Medline for

  • Luciano Mastronardi - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Guglielmo Cacciotti - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Franco Caputi - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Ettore Di Scipio - San Filippo Neri Hospital, Department of Neurological Sciences, Unit of Neurophysiopathology, Roma, Italy
  • Giuseppe Parziale - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Alessandro Rinaldi - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Raffaele Roperto - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Shahram Sherkat - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Maria Pia Tonelli - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
  • Ettore Carpineta - San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.15.05

doi: 10.3205/15dgnc177, urn:nbn:de:0183-15dgnc1778

Published: June 2, 2015

© 2015 Mastronardi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: The aim of this study was to analyze the results of microsurgery in acoustic neuromas (AN) excision with assistance of two different flexible hand-held laser fibers, CO2 (Omniguide®) and 2μm-Thulium (Revolix jr®), using the retrosigmoid (RS) approach. We performed a retrospective non-randomized clinical study.

Method: From July, 2010 to October, 2014, 64 consecutive patients suffering from AN were operated on with microsurgical technique via the RS approach. In 30 cases tumor resection was performed with the aid of a hand-held flexible laser (L-group): in 8 cases a CO2 laser and in 26 a 2μm-Thulium laser fiber was used. Thirty patients with AN operated on with microsurgical standard technique, without the laser, were used as comparison group (C-group) (matched-pair-technique).

Results: Overall time from incision to skin suture changed in relation to size of tumor (from 165 to 575 minutes) and was not affected by the use of hand-held laser. Facial nerve function was clinically assessed with the House-Brackmann (HB) scale (I-IV) preoperatively, in the early postoperative period (after 1 week), and at 6-month follow-up. In 2 cases a preoperative facial nerve palsy was observed (HB III and HB IV, respectively). In the remaining 62 cases, facial nerve preservation rate (HB I) was 88,7%, after 6 months. Hearing preservation rate (AAO-HNS A and B, pre- and postoperatively) was 64,3%% (18 out of 28). Adopting a 0-3-scale, the mean surgeon satisfaction rate of usefulness of hand-held laser fiber was 2,7.

Conclusions: The use of a handheld flexible CO2 and 2μm-Thulium laser fiber in AN-microsurgery seems to be safe and subjectively facilitates tumor resection especially in "difficult" conditions (e.g., highly vascularized or hard tumors). However, in this limited retrospective trial the good functional outcome following conventional microsurgery could not be further improved, nor the surgical time reduced by means of the non-contact laser-tool. Focusing the use of the flexible hand-held lasers on "difficult" (large and vascularized) tumors may lead to different results in future.