Introduction: The main goal of modern neurosurgery consists of maximal tumor excision with minimization of morbidity and mortality. During the years, many tools have improved the surgical performances: refined bipolar forceps, microsurgical instruments, ultrasonic aspirators, lasers.
The CO2 Laser has shown to be effective for years in the surgical armamentarium used for the removal of intracranial tumors, mostly for benign skull base neoplasms. Recently, the possibility to use the CO2 Laser with flexible hand-held fiber relaunched its applications. We have started to use the hand-held CO2 Laser during the surgical removal of selected intracranial tumors, for cutting, coagulating, and vaporizing, evaluating its efficacy and safety.
Methods: From July 2010 to March 2013, we used the CO2 Laser in the removal of 57 intracranial tumors. Among these, 15 were skull base tumors (SBT: 5 anterior clinoid meningiomas, 5 median anterior cranial fossa meningiomas, 2 middle cranial fossa meningiomas 2 skullbase-neck schwannomas, and 1 hemangiopericytoma,) and 18 posterior fossa tumors (PCFT: 11 meningiomas, 6 schwannomas, 1 malignant epidermoid cyst).
Results: We did not observe morbidity nor mortality related to the CO2 Laser. Postoperative MRI confirmed total removal in 10 SBT and in 7 PCFT; subtotal removal in 5 and 8, and partial removal in 2 and 3, respectively. As regards the CO2 Laser functions (mean percentage of use), the cut/coagulation/vaporization ratio was 70/3/27 in SBT and 62.5/12/25.5 in PCFT. In meningiomas, both in skull base and in posterior fossa, the ratio was 65/6.5/28.5 versus 71/10/19 of schwannomas. The CO2 Laser was very useful in the vaporization and microcoagulation of the base of implant and dural attachment of meningiomas.
By using a 1 to 5 evaluation scale (1 no useful, 5 extremely useful), the mean value was 4 (3.8 for SBT and 4.1 for PCFT, respectively). In relation to hystological subgroups, the mean value was 4.2 for meningiomas, 3.6 for schwannomas, and 5 in the case of malignant epidermoid cyst.
Conclusions: The hand-held CO2 Laser offers a valuable aid in the removal of intracranial tumors, for cutting (capsule, fibrous masses), coagulating (microvessels) e vaporizing (debulking, removal of base of implant). Multicentric studies on large series are warranted.
Patient Care: Better surgical results with less morbidity
Learning Objectives: Usefulness of hand-held CO2 laser for skull base and posterior cranial fossa tumor resection