TY - JOUR
T1 - Flexible Fiber CO 2 Laser in Microsurgical Treatment of Intraventricular Tumors
T2 - Usefulness and Limitations
AU - Policicchio, Domenico
AU - Dipellegrini, Giosuè
AU - Muggianu, Giampiero
AU - Pintus, Adriana
AU - Sgaramella, Enrico
AU - Veneziani Santonio, Filippo
AU - Boccaletti, Riccardo
PY - 2018/2
Y1 - 2018/2
N2 - 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.
AB - 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.
KW - Carbon dioxide
KW - Cerebrospinal fluid
KW - CO
KW - CO laser
KW - Computed tomography
KW - CSF
KW - CT
KW - Magnetic resonance imaging
KW - Microsurgery
KW - MRI
KW - Neurosurgery
KW - OmniGuide
KW - Ventricular tumors
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U2 - 10.1016/j.wneu.2018.10.065
DO - 10.1016/j.wneu.2018.10.065
M3 - Article
C2 - 30342263
AN - SCOPUS:85056343661
VL - 122
SP - e427-e435
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
ER -