Safety and usefulness of flexible hand-held laser fibers in microsurgical removal of acoustic neuromas (vestibular schwannomas)

Aims: We performed a retrospective non-randomized study to analyze the results of microsurgery of acoustic neuromas (AN) using two different flexible hand-held laser fibers, CO2 (Omniguide(®)) and 2μ-Thulium (Revolix jr(®)).

Methods: From September 2010 to June 2015, 84 patients suffering from AN have been operated on with microsurgical technique via retrosigmoid (RS) approach. In 42 cases tumor resection was performed with the assistance of hand-held flexible laser (L-group): in 8 cases CO2-fiber and in 34 2μ-Thulium-fiber. Fortytwo patients, operated on without laser-assistance, were used as comparison group (C-group) (matched-pair-technique). Facial nerve function was assessed with the House-Brackmann (HB) scale preoperatively, 1 week postoperatively, and 6-month or more after surgery.

Results: Overall time from incision to skin suture changed in relation to size of tumor (165-575min) and was not affected by the use of laser. In 2 cases preoperative facial nerve palsy was observed. In the remaining 82 cases, at 6-month follow-up facial nerve preservation rate (HB I) was 90.2%. Hearing preservation rate (AAO-HNS A/B classes) was 68.4% (26 out of 38). Adopting a 0-3-scale, the mean surgeon satisfaction rate of usefulness of laser fiber was 2.64.

Conclusions: The use of a 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.