Flexible Fiber CO 2 Laser in Microsurgical Treatment of Intraventricular Tumors: Usefulness and Limitations

Domenico Policicchio, Giosuè Dipellegrini, Giampiero Muggianu, Adriana Pintus, Enrico Sgaramella, Filippo Veneziani Santonio, Riccardo Boccaletti

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess usefulness and limitations of flexible fiber carbon dioxide (CO 2 ) laser in the microsurgical treatment of intraventricular tumors. Methods: We reviewed a series of 9 patients treated with microsurgical resection of intraventricular tumors using a flexible fiber CO 2 laser. The lesions involved the third ventricle (8) and the frontal horn of the right lateral ventricle (1). Histology revealed 6 craniopharyngiomas, 1 pituitary macroadenoma, 1 subependymoma, and 1 neurocytoma. In all cases, an interhemispheric transcallosal approach was performed. The laser was used during callosotomy, fornix column sectioning, tumor debulking, and to facilitate tumor dissection. We used a 5-tiered score system to assess laser's efficacy in each surgical step (approach, dissection, debulking): grade 1: laser was not at all helpful, grade 5: laser was extremely helpful. Limits of the instrument also are discussed. Results: Gross total resection was achieved in 6 cases and subtotal resection in the remaining 3. Three patients had pulmonary complications treated without clinical sequelae. No laser-related complication was described. Mean utility score observed was 4.2 (range 3–5) during approach, 2.8 (range 2–4) during tumor dissection; and 3.3 (range 2–5) during tumor debulking. Main limits were low hemostatic effect and inefficiency versus calcified and highly vascularized tumors. Conclusions: The CO 2 laser proved to be a useful and safe tool that could be used for intraventricular pathology; its design is suitable for narrow surgical corridors like interhemispheric fissure and foramen of Monro; its main utility is the ability to create precise and relatively bloodless cut (callosotomy, tumor debulking); low hemostatic effect is its main limit.

Original languageEnglish
Pages (from-to)e427-e435
JournalWorld Neurosurgery
Volume122
DOIs
Publication statusPublished - Feb 2018

Keywords

  • Carbon dioxide
  • Cerebrospinal fluid
  • CO
  • CO laser
  • Computed tomography
  • CSF
  • CT
  • Magnetic resonance imaging
  • Microsurgery
  • MRI
  • Neurosurgery
  • OmniGuide
  • Ventricular tumors

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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