Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach

Scheich, Matthias; Ginzkey, Christian; Harnisch, Wilma; Ehrmann, Desiree; Shehata‐Dieler, Wafaa; Hagen, Rudolf

doi:10.1007/s00405-011-1791-8

Cited by 19 publications

(10 citation statements)

References 39 publications

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“…After identifying the important landmarks (greater superficial petrosal nerve, arcuate eminence, superior petrosal sinus, and superior semicircular canal), the roof of the internal auditory canal is drilled off to incise the intrameatal dura. In most cases, we perform a noncontact tumor debulking with a carbon-dioxide (CO 2 ) laser (Omniguide Inc., Cambridge, MA, USA) [9] before the sharp resection of the tumor capsule. The IAC is plugged thoroughly with a temporalis muscle graft in combination with fibrin glue.…”

Section: Middle Fossa Approachmentioning

confidence: 99%

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Scheich

Ginzkey²,

Müller³

et al. 2017

Int Adv Otol

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Section: Middle Fossa Approachmentioning

confidence: 99%

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Scheich

Ginzkey²,

Müller³

et al. 2017

Int Adv Otol

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“…Alternatively we prefer to use a flexible CO2 laser fibre (Omniguide ® Inc., Lexington, MA, USA), as this allows for a contactless tumour resection (Fig. 3.4.3) without damaging the facial or the cochlear nerve, which run alongside the surface of the tumour 20 . Parts of the tumour can be luxated using a small 45° hook.…”

Section: The Lateral Approaches: Principles and Highlightsmentioning

confidence: 99%

Surgery of the lateral skull base: a 50-year endeavour

Zanoletti¹,

Mazzoni²,

Martini³

et al. 2019

Acta Otorhinolaryngol Ital

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SUMMARY Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

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“…The flexible CO 2 laser fiber was introduced in 2002. The possibility to guide the laser beam through straight or curved applicators allows precise and targeted manipulations of complex anatomical sites, which made this technology attractive for several microsurgical approaches [ 9 , 10 ]. Since 2010, flexible CO 2 laser fiber supplements conventional bipolar cauterization techniques in vestibular schwannoma and TJP surgery at the study center [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical management of tympanojugular paragangliomas using the flexible CO2 laser

Hackenberg

Meyer

Häfner

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Surgery is a standard therapy for tympanojugular paragangliomas (TJP). Maintaining the quality of life (QoL) requires functional preservation. The flexible CO2 laser allows contact-free tumor removal. This retrospective study compares the postoperative functional outcomes of TJP surgery with and without the flexible CO2 laser. Methods Between 2005 and 2019, 51 patients with TJP were surgically treated at a tertiary hospital. Until 2012, 17 patients received conventional surgery. Thereafter, the flexible laser was used in 34 patients. Tumor extend, pre- and postoperative cranial nerve function, and complications were compared between the groups. Results The cohort consisted of 33 class A and B tumors and 18 class C and D tumors. Preoperative embolization was performed in 17 cases. Class C/D TJP were usually removed via an infratemporal fossa type A approach. Gross total tumor removal was achieved in 14/18 class C/D tumors. 3/51 patients suffered from long-term partial or complete facial palsy. No differences in post-therapeutic cranial nerve function or complications were noted between the conventional and laser group. One recurrence was observed after complete tumor resection. Conclusion The flexible CO2 laser was shown to be a safe and effective alternative to conventional bipolar cauterization, which is appreciated by the surgeon in these highly vascularized tumors. Both techniques allowed a high tumor control rate and good long-term results also from a functional point of view.

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Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach

Cited by 19 publications

References 39 publications

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Surgery of the lateral skull base: a 50-year endeavour

Surgical management of tympanojugular paragangliomas using the flexible CO2 laser

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