Laser microsurgery: A review of 105 intracranial tumors

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 less than 0.000001) and the mean operating time (299 minutes vs 237 minutes; p less than 0.00001) was longer, but there was no significant mean difference in mortality, CNS morbidity, mean blood loss (638 ml vs 671 ml) 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 less than 0.0002) and the mean operating time was slightly longer (p less than 0.02). The length of stay for laser cases tended to be less (21 vs 27 days; p less than 0.04), but there was again no difference in blood loss (457 ml vs 522 ml), CNS morbidity (7.8 vs 4.8%) or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Current Management of Low-Grade Astrocytomas of Childhood

“…It is most valuable when used to resect deep, relatively avascular tumors which must be approached through small cortical incisions to protect neurologic function. A radical excision of a glial tumor can be satis factorily accomplished in virtually any hemispheric lo cation using proper technique [24] and the use of the in strument is generally felt to make surgery safer and faster, but this has not been demonstrated statistically [24], Similarly, although use of the laser has permitted more aggressive resections of astrocytomas than con ventional techniques, it is difficult to say whether this has improved longevity.…”

Application of Novel CO2 Laser-Suction Device

“…Retrospective studies comparing the CO 2 laser to other techniques demonstrated an increased operative time, increased number of reoperations, and no change in outcomes (except in the case of meningiomas located in functional regions). 30,31 The advent of the flexible OmniGuide fiber has enhanced the utility of the CO 2 laser, overcoming ergonomic obstacles that limited the efficient use of line-of-sight CO 2 lasers. Reports of Omni-Guide CO 2 laser use in the surgical management of numerous central nervous system pathologies has recently been described.…”

Beneficial Use of a New Hand-Held CO2 Laser Fiber in Resection of a Calcified and Vascular Intraventricular Tumor

“…In a review of 321 intracranial tumors, 105 of which were treated with a line-of-sight CO 2 laser, Salcman et al (41) found no significant difference between laser and nonlaser groups in terms of mortality, CNS morbidity, blood loss, or length of hospital stay. The number of reoperations in the laser group (60.1%) was greater than in the nonlaser group (32.7%), as was mean operative time (299 minutes vs 237 minutes) (41).…”

“…In a review of 321 intracranial tumors, 105 of which were treated with a line-of-sight CO 2 laser, Salcman et al (41) found no significant difference between laser and nonlaser groups in terms of mortality, CNS morbidity, blood loss, or length of hospital stay. The number of reoperations in the laser group (60.1%) was greater than in the nonlaser group (32.7%), as was mean operative time (299 minutes vs 237 minutes) (41). In a similar study of 198 gliomas and 220 meningiomas operated on with either laser or conventional techniques, Lombard et al (31) found laser treatment to be associated with improved morbidity and quality of life in patients with glioma after resection.…”