Luciano Mastronardi - MD, PhD, San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
Guglielmo Cacciotti - MD, San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
Raffaele Roperto - MD, San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy
Maria Tia-Tonelli - MD, San Filippo Neri Hospital, Department of Neurological Sciences, Division of Neurosurgery, Roma, Italy

Background: Vestibular Schwannoma (VS) is one of the skull base tumorsoriginating from vestibular portion of eighth cranial nerve. Recently, 2 micro-Thulium laser is used in the surgery of some intracranial tumors.Objectives: Assessing the efficacy of 2 micro-Thulium flexible hand-held laserfiber (RevolixjrÒ) in microsurgical removal of VS.Materials and Methods: This retrospective non-randomized study was carriedout from July 2012 to November 2015. 39 patients with VS had been operatedon with microsurgical technique via retro-sigmoid approach. 2 micro-Thuliumfiberhand-held flexible laser was used for tumor resection in 39 cases. Facialnerves function by House-Brackmann (HB) scale and hearing state wereassessed preoperatively and 1 week and 6-month postoperatively.Results: Overall time of surgery changed only in proportion with the size oftumor (185-575 minutes) and was not affected by the use of laser. In 5out of39cases, preoperative facial nerve palsy HB2, and in one case HB4 (permanent)was observed. On considering 38 cases, at 6-month follow-up facial nervepreservation rate (HB1) was 92.1% (from May 2015 all patients had notpostoperative facial palsy). Hearing preservation rate was possible in 12 out of15 cases with previously acceptable preoperative hearing state (AAO-HNS Aand B classes). The mean surgeon satisfaction rate of usefulness of this technicwas 2.7 in a 0-3-scaleConclusions: A good functional outcome including facial nerve preservationand hearing preservation was obtained by micro-Thulium-fiber hand-heldflexible laser microsurgery.

Vestibular Schwannoma; Facial Nerve Preservation; Hearing Preservation; 2-micro Thulium Laser