Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany.
Eur Arch Otorhinolaryngol. 2012 May;269(5):1417-23. doi: 10.1007/s00405-011-1791-8. Epub 2011 Oct 4.
The aim of this study was to analyze the results of microsurgery in vestibular schwannomas (VS) with assistance of a flexible CO(2) laser fiber (Omniguide(®)) using the middle cranial fossa (MCF) approach. For that purpose we performed a prospective non-randomized clinical trial. In 20 consecutive patients suffering from VS and elected for microsurgery via the MCF approach, tumor resection was performed with the aid of the flexible CO(2) laser ("laser group", LG). Twenty patients with similar tumor volume and pre-operative hearing status out of a cohort of 76 patients previously treated by the same surgeon without laser were used as comparison group ("conventional group", CG) (matched-pair-technique). Facial weakness (House-Brackmann (HB) 2-4) was seen in early postoperative (p.o.) days in six patients in each group and all recovered completely by 3 months p.o., except one patient with HB 2 in CG. Facial nerve preservation rate (HB 1 + 2) was 100% in both groups. Hearing preservation rate (Gardner/Robertson class 1 + 2 or AAO-HNS A + B, pre- and postoperatively) was 72% in LG and 82% in CG, without significant difference. Overall time from incision to skin suture was 157 min (SD 55.9) in CG and 160 min (SD 39.7) in LG. Tumor preparation time was 23.2 min (SD 19.7) in CG and 36.1 min (SD 33.8) in LG. The use of a handheld flexible CO(2) laser fiber in VS-microsurgery is safe and subjectively facilitates tumor resection especially in "difficult" (e.g., highly vascularized) tumors. However, in this limited prospective trial the excellent functional outcome following conventional microsurgery could not be further improved, nor the surgical time reduced by means of the non-contact laser-tool. Focusing the use of the flexible CO(2) laser on "difficult" tumors may lead to different results in future.
本研究旨在分析使用颅中窝（MCF）入路的柔性 CO2 激光纤维（Omniguide®）辅助下治疗前庭神经鞘瘤（VS）的手术结果。为此，我们进行了一项前瞻性非随机临床试验。在 20 例连续就诊并选择 MCF 入路行显微镜下切除术的 VS 患者中，肿瘤切除在柔性 CO2 激光的辅助下进行（激光组，LG）。从同一外科医生既往治疗的 76 例患者中，选择肿瘤体积和术前听力状况相似的 20 例患者作为对照组（“常规组”，CG）（配对技术）。在术后早期（p.o.），两组各有 6 例患者出现面瘫（House-Brackmann 分级 2-4），所有患者均在术后 3 个月内完全恢复，CG 组仅有 1 例患者为 HB2 级。两组面神经保留率（HB1+2）均为 100%。听力保留率（Gardner/Robertson 分级 1+2 或 AAO-HNS A+B，术前和术后）在 LG 组为 72%，CG 组为 82%，无显著差异。CG 组切口至缝合皮肤的总时间为 157 分钟（SD 55.9），LG 组为 160 分钟（SD 39.7）。CG 组肿瘤准备时间为 23.2 分钟（SD 19.7），LG 组为 36.1 分钟（SD 33.8）。在 VS 显微镜手术中使用手持柔性 CO2 激光纤维是安全的，主观上可促进肿瘤切除，特别是在“困难”（如高度血管化）肿瘤中。然而，在这项有限的前瞻性试验中，常规显微镜手术的出色功能结果未能进一步改善，手术时间也未因非接触式激光工具而缩短。将柔性 CO2 激光的应用重点放在“困难”肿瘤上，可能会在未来得出不同的结果。
