Microsurgical removal of vestibular schwannomas with flexible hand-held 2μ-Thulium-fiber laser. Personal experience in 78 consecutive cases

Abstract

Aims: We performed a retrospective non-randomized study to analyze the results of microsurgery of vestibular schwannomas (VS) using 2μ-Thulium flexible hand-held laser fiber (Revolix jr®). Methods: From September 2010 to November 2018, 180 patients suffering from VS have been operated on with microsurgical technique via retrosigmoid (RS) approach in our Department. From July 2012 to April 2018, tumor resection was performed in 78 cases with the assistance of 2μ-Thulium-fiber hand-held flexible laser. Facial nerve function was assessed with the House-Brackmann (HB) scale preoperatively, 1 week postoperatively, and 6-month after surgery. Results: Overall time from incision to skin suture changed in relation to size of tumor (185–575 min) and was not affected by the use of laser. In 5 out of 78 cases preoperative facial nerve palsy HB2 and in one case HB4 (permanent) was observed. On considering 77 cases (excluding 1 permanent HB4) with a minimum 6-month follow-up, facial nerve preservation rate (HB1) was 92,2%. Hearing preservation rate (AAO-HNS A/B classes) was possible in 17 out of 30 cases (56,7%). Adopting a 0–3-scale, the mean surgeon satisfaction rate of usefulness of laser fiber was 2,75. Conclusions: The use of 2μ-Thulium-fiber hand-held flexible laser in VS-microsurgery seems to be safe and to facilitate tumor resection, especially in “difficult” conditions (e.g., highly vascularized and hard tumors). In this retrospective trial, the good functional outcome following conventional microsurgery had not further improved, nor the surgical time reduced by laser. Focusing its use on “difficult” (large and vascularized) cases may lead to different results in future. Keywords: Acoustic neuroma, Facial nerve preservation, Hearing preservation, Retrosigmoid approach, 2μ-Thulium laser, Vestibular schwannoma