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

  • Otology
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Abstract

The aim of this study was to analyze the results of microsurgery in vestibular schwannomas (VS) with assistance of a flexible CO2 laser fiber (Omniguide®) using the middle cranial fossa (MCF) approach. For that purpose we performed a prospective non-randomized clinical trial. In 20 consecutive patients suffering from VS and elected for microsurgery via the MCF approach, tumor resection was performed with the aid of the flexible CO2 laser (“laser group”, LG). Twenty patients with similar tumor volume and pre-operative hearing status out of a cohort of 76 patients previously treated by the same surgeon without laser were used as comparison group (“conventional group”, CG) (matched-pair-technique). Facial weakness (House-Brackmann (HB) 2-4) was seen in early postoperative (p.o.) days in six patients in each group and all recovered completely by 3 months p.o., except one patient with HB 2 in CG. Facial nerve preservation rate (HB 1 + 2) was 100% in both groups. Hearing preservation rate (Gardner/Robertson class 1 + 2 or AAO-HNS A + B, pre- and postoperatively) was 72% in LG and 82% in CG, without significant difference. Overall time from incision to skin suture was 157 min (SD 55.9) in CG and 160 min (SD 39.7) in LG. Tumor preparation time was 23.2 min (SD 19.7) in CG and 36.1 min (SD 33.8) in LG. The use of a handheld flexible CO2 laser fiber in VS-microsurgery is safe and subjectively facilitates tumor resection especially in “difficult” (e.g., highly vascularized) tumors. However, in this limited prospective trial the excellent functional outcome following conventional microsurgery could not be further improved, nor the surgical time reduced by means of the non-contact laser-tool. Focusing the use of the flexible CO2 laser on “difficult” tumors may lead to different results in future.

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Acknowledgments

The laser fibers and filters required for surgery have been provided by Omniguide® Inc. (Cambridge, MA, USA).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany

    Matthias Scheich, Christian Ginzkey, Wilma Harnisch, Desiree Ehrmann, Wafaa Shehata-Dieler & Rudolf Hagen

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  1. Matthias Scheich
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Correspondence to Matthias Scheich.

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Scheich, M., Ginzkey, C., Harnisch, W. et al. Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach. Eur Arch Otorhinolaryngol 269, 1417–1423 (2012). https://doi.org/10.1007/s00405-011-1791-8

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