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J Neurol Surg B Skull Base 2017; 78(04): 301-307
DOI: 10.1055/s-0037-1598202
Original Article
Georg Thieme Verlag KG Stuttgart · New York

How I Do It: The Role of Flexible Hand-held 2μ-Thulium Laser Fiber in Microsurgical Removal of Acoustic Neuromas

Luciano Mastronardi
1   Division of Neurosurgery, Department of Neurological Sciences, San Filippo Neri Hospital, Roma, Italy
,
Guglielmo Cacciotti
1   Division of Neurosurgery, Department of Neurological Sciences, San Filippo Neri Hospital, Roma, Italy
,
Raffaele Roperto
1   Division of Neurosurgery, Department of Neurological Sciences, San Filippo Neri Hospital, Roma, Italy
,
Maria Pia Tonelli
1   Division of Neurosurgery, Department of Neurological Sciences, San Filippo Neri Hospital, Roma, Italy
,
Ettore Carpineta
1   Division of Neurosurgery, Department of Neurological Sciences, San Filippo Neri Hospital, Roma, Italy
› Author Affiliations
Further Information

Publication History

30 December 2015

18 May 2016

Publication Date:
08 February 2017 (online)

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Abstract

Aims We performed a retrospective nonrandomized study to analyze the results of microsurgery of acoustic neuromas (AN) using 2μ-thulium flexible hand-held laser fiber (Revolix jr).

Methods From September 2010 to September 2015, 89 patients suffering from AN have been operated on with microsurgical technique via retrosigmoid approach. In 37 cases, tumor resection was performed with the assistance of 2μ-thulium flexible hand-held laser fiber (L-group). Eight cases operated on with the assistance of CO2 hand-held flexible laser fiber were excluded from this study. A total of 44 patients, operated on without laser assistance during the same period, were used as comparison group (C-group) (matched pair technique). Facial nerve function was assessed with the House–Brackmann (HB) scale preoperatively, and 1 week and 6 months postoperatively.

Results Overall time from incision to skin suture changed in relation to size of tumor (165–575 minutes) and was not affected by the use of laser. In 7 out of 81 cases, a preoperative facial nerve palsy HB2 and in 1 case, HB4 (permanent) were observed. In the remaining 80 cases, at 6-month follow-up, facial nerve preservation rate (HB1) was 92.5%. Hearing preservation rate (AAO-HNS A/B classes) was 68.2% (26 out of 36). Adopting a 0 to 3 scale, the mean surgeon satisfaction rate of usefulness of laser fiber was 2.7.

Conclusion The use of 2μ-thulium hand-held flexible laser fiber in AN microsurgery seems to be safe and subjectively facilitates tumor resection especially in “difficult” conditions (e.g., highly vascularized and hard tumors). In this limited retrospective trial, the good functional outcome following conventional microsurgery 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.

Keywords

acoustic neuroma - facial nerve preservation - hearing preservation - retrosigmoid approach - 2µ-thulium laser - vestibular schwannoma
 

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