Laser microsurgery: A review of 110 tumors of the brain and spinal cord

  • Michael Salcman
  • Walker Robinson
  • Elizabeth Montgomery

Abstract

The relative importance or utility of the carbon dioxide laser within the total context of multimodality therapy and in comparison to conventional surgical techniques is unknown. Over a 36 month period, 421 operations for tumors of the brain and spinal cord were performed in our clinic. Of these, 111 (26%) were carried out with the aid of the laser. After excluding stereotactic and transsphenoidal operations, a comparison was made between 105 laser and 216 non-laser craniotomies. With the exception of pituitary tumors, the most frequent diagnoses in both the laser and non-laser cases were the same: malignant astrocytoma (48.6 vs 33.9%), meningioma (11.4 vs 14.2%) and low grade astrocytoma (8.6 vs 8.7%). The number of reoperations in the laser group (60.1%) was higher than in the non-laser group (32.7%; p<0.000001) and the mean operating time (299 minutes vs 237 minutes; p<.00001) was longer, but there was no significant mean difference in mortality, CNS morbidity, mean blood loss (638 ml vs 671ml) or mean length of stay (23 vs 25 days). For the subgroup of 134 cases of malignant astrocytoma, 82% of laser procedures were reoperations versus 50% for non-laser cases (p<0.0002) and the mean operating time was slightly longer (p<0.02). The length of stay for laser cases tended to be less (21 vs 27 days; p<0.04), but there was again no difference in blood loss (457ml vs 522ml), CNS morbidity (7.8 vs 4.8%) or mortality. We conclude that the essential equivalence in outcomes, despite a higher number of reoperations and difficult benign tumors in the laser group, may indicate the usefulness of the laser but that less than 25% of all tumor patients will benefit from this surgical tool. It is not possible to statistically demonstrate the benefits of laser surgery by standard measures of outcome.

Key words

craniotomy astrocytoma meningioma schwannoma glioblastoma carbon dioxide laser 

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Copyright information

© Martinas Nijhoff Publishers, Boston 1986

Authors and Affiliations

  • Michael Salcman
    • 1
  • Walker Robinson
    • 1
  • Elizabeth Montgomery
    • 1
  1. 1.The N’euro-Oncology Service, Division of Neurological SurgeryUniversity of Maryland HospitalBaltimore, MarylandUSA

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