Introduction: Since 1960, lasers have been used for surgical removal of intracranial tumors. Because of limited penetration through tissues and of wavelength, lasers are attractive for application during microsurgical removal of meningiomas and schwannomas. The aim of this study is to evaluate the usefulness of 2-µ-thulium and CO2 lasers.
Methods: From July 2010, 79 patients with a diagnosis of intracranial meningioma (52) or schwannoma (27) were operated on in our Department using a hand-held laser. In 61, the tumor involved the skullbase.
In 50 cases CO2 and in 29 2-µ-thulium lasers have been used together with bipolar forceps (BF), ultrasonic aspirator (UA), and microsurgical instruments. Excision of tumors consisted of four phases: (1) devascularization; (2) debulking; (3) dissection from deep structures; (4) detachment and removal from base of implant. During these steps, we evaluated the percentage of use of laser and the surgeon satisfaction rate (scale: 0-3).
Results: Both lasers were used mainly during phases 2 (together with UA and BF) and 4 (together with BF), 60% and 30%, respectively. Thulium laser was also used for devascularizarion of external surface of tumor. Traditional dissection with scissors and microdissectors was preferred for phase 3. Surgeon satisfaction rate was 2,74 for CO2 and 2,62 for thulium laser, respectively (p>0,05).
Conclusions: Thulium and CO2 lasers seem to be useful in the surgery of intracranial meningiomas and schwannomas, especially for debulking and shrinking the mass, and for coagulating the mass and the basal implant. Thulium laser seems to be more indicated in bleeding and CO2 in hard tumors.
Patient Care: Thulium laser seems to be very useful in bleeding and CO2 in hard intracranial tumors.
Learning Objectives: Utility of hand-held lasers in surgical removal of intracranial meningioma and schwannomas