Use of a flexible hollow-core carbon dioxide laser for microsurgical resection of vestibular schwannomas

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The CO<jats:sub>2</jats:sub> laser has been used on an intermittent basis in the microsurgical resection of brain tumors for decades. These lasers were typically cumbersome to use due to the need for a large, bulky design since infrared light cannot be transmitted via fiber-optic cables. Development of the OmniGuide cable, which is hollow and lined with an omnidirectional dielectric mirror, has facilitated the reintroduction of the CO<jats:sub>2</jats:sub> laser in surgical use in a number of fields. This device allows for handheld use of the CO<jats:sub>2</jats:sub> laser in a much more ergonomically favorable configuration, holding promise for microneurosurgical applications. This device was introduced into the authors’ practice for use in the microsurgical resection of skull base tumors, including vestibular schwannomas.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors reviewed the initial 41 vestibular schwannomas that were treated using the OmniGuide CO<jats:sub>2</jats:sub> laser during an 8-month period from March 2010 to October 2010. The laser was used for all large tumors, and select medium-sized tumors were treated via both the translabyrinthine and retrosigmoid approaches. The estimated time of tumor resection and estimated blood loss were obtained from operating room records. Data regarding complications, facial nerve and hearing outcomes, and further treatment were collected from hospital and clinic records, MRI reports, and direct review of MR images. Time of resection and blood loss were compared to a control group (n = 18) who underwent surgery just prior to use of the laser.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 41 patients with vestibular schwannomas were surgically treated. The median estimated time of tumor resection was 150 minutes, and the median estimated blood loss was 300 ml. The only operative complication was 1 CSF leak. Thirty-eight patients had normal facial nerve function at late follow-up. The median MRI follow-up was 52 months, and, during that time, only 1 patient required further treatment for regrowth of a residual tumor.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The OmniGuide CO<jats:sub>2</jats:sub> laser is a useful adjunct in the resection of large vestibular schwannomas. This device was used primarily as a cutting tool rather than for tumor vaporization, and it was found to be of most use for very large and/or firm tumors. There were no laser-associated complications, and the results compared favorably to earlier reports of vestibular schwannoma resection.</jats:p></jats:sec>

Flexible fiber‐based CO2 laser vs monopolar cautery for resection of oral cavity lesions: A single center randomized controlled trial assessing pain and quality of life following surgery

“… 30 In addition to head and neck sites, these lasers have recently been studied in the neurosurgical environment, where they were shown to be a valuable tool in the resection of vestibular schwannomas. 32 , 33 This research demonstrates various benefits to these instruments in anatomical locations where preserving function is vitally important. Given that the oral cavity is necessary for speech and swallowing, exploring function preserving techniques, like the use of the carbon dioxide laser, in this region should be a focus of ongoing research.…”

“…They noted lower levels of postoperative pain in their laser cohort when compared to the electrocautery cohort 30 . In addition to head and neck sites, these lasers have recently been studied in the neurosurgical environment, where they were shown to be a valuable tool in the resection of vestibular schwannomas 32,33 . This research demonstrates various benefits to these instruments in anatomical locations where preserving function is vitally important.…”

Vestibularisschwannom: Faktoren bei der Therapieentscheidung

“…Bei schwierigen (z.B. stark vaskularisierten) VS kann die Verwendung eines flexiblen Lasers die Operation erleichtern [51,52,53].…”