Safety and usefulness of flexible hand-held laser fibers in microsurgical removal of acoustic neuromas (vestibularschwannomas)

 2016 Jun;145:35-40. doi: 10.1016/j.clineuro.2016.03.019. Epub 2016 Mar 25.

Authors: Luciano Mastronardi,∗, Guglielmo Cacciotti, Ettore Di Scipio, Giuseppe Parziale,Raffaelino Roperto, Maria Pia Tonelli, Ettore Carpineta

Aims: We performed a retrospective non-randomized study to analyze the results of microsurgery ofacoustic neuromas (AN) using two different flexible hand-held laser fibers, CO2(Omniguide®) and 2 -Thulium (Revolix jr®).Methods: From September 2010 to June 2015, 84 patients suffering from AN have been operated on withmicrosurgical technique via retrosigmoid (RS) approach. In 42 cases tumor resection was performed withthe assistance of hand-held flexible laser (L-group): in 8 cases CO2 fiber and in 34 2 -Thulium-fiber.

Forty two patients, operated on without laser-assistance, were used as comparison group (C-group)(matched-pair-technique).

Facial nerve function was assessed with the House-Brackmann (HB) scale preoperatively, 1 weekpostoperatively, and 6-month or more after surgery.

Results: Overall time from incision to skin suture changed in relation to size of tumor (165–575 min)and was not affected by the use of laser. In 2 cases preoperative facial nerve palsy was observed. Inthe remaining 82 cases, at 6-month follow-up facial nerve preservation rate (HB I) was 90.2%. Hearingpreservation rate (AAO-HNS A/B classes) was 68.4% (26 out of 38). Adopting a 0–3 scale, the mean surgeonsatisfaction rate of usefulness of laser fiber was 2.64.

Conclusions: The use of a hand-held flexible laser fiber in AN-microsurgery seems to be safe and subjec-tively facilitates tumor resection especially in “difficult” conditions (e.g., highly vascularized and hardtumors). In this limited retrospective trial, the good functional outcome following conventional micro-surgery had not further improved, nor the surgical time reduced by laser. Focusing its use on “difficult”(large and vascularized) cases may lead to different results in future.© 2016