Application Of Contact Laser During Neurosurgical Procedure For The Tumors In Central Nervous System

Objective: To investigate the application of contact laser during neurosurgical procedure for the tumors in central nervous system.Methods: The clinical data of 223 patients with central nervous system tumors(CNST)in the People’s Hospital of Guizhou Province between June 2010 to February 2015 were retrospectively reviewed. The patients were divided into 2 groups,in which test group was accepted microneurosurgery with contact laser, control group was received routine microneurosurgery. 115 cases were randomly assigned to test group, including parasagittal meningioma in 35 cases, olfactory groove meningioma in 29 cases, sphenoid ridge meningioma in 17 cases, trigeminal neurinoma in 7 cases,acoustic neuroma in 23 cases, spinal meningioma in 15 cases, brainstem glioma in 4cases. 108 cases were randomly assigned to control group, including parasagittal meningioma in 32 cases, olfactory groove meningioma in 15 cases, sphenoid ridge meningioma in 19 cases, trigeminal neurinoma in 5 cases, acoustic neuroma in 20 cases, spinal meningioma in 14 cases, brainstem glioma in 3 cases.The extent of tumor resection, amount of bleeding during operation, protection of crucial blood vessels and nerves were analyzed.Results:1. Tumor resection degree:1.1 In test group, Simpson II grade resection was achieved in all 35 cases with parasagittal meningioma, and Simpson I grade resection in 14 cases and Simpson II grade resection in 3 cases with sphenoid ridge meningioma, and Simpson I grade resection in 10 cases and Simpson II grade resection 4 cases with olfactory groove meningioma. In control group, Simpson II grade resection was achieved in22 cases with parasagittal meningioma, and Simpson II grade resection in 15 cases with sphenoid ridge meningioma, and Simpson I grade resection in 2 cases and Simpson II grade resection 10 cases with olfactory groove meningiomas. The data were analyzed by chi-square test and showed that the differences in tumor resection degree between the two groups had statistical significance(χ21=12.856,P1=0.000;χ22=25.969,P2=0.000;χ23=10.883,P3=0.004)*.1.2 In test group, complete resection was achieved in 6 cases and subtotal resection in1 case with trigeminal neurinoma, and complete resection in 21 cases and subtotal resection in 2 cases with acoustic neuroma, and complete resection in 14 casesand subtotal resection in 1 case with spinal meningioma, and complete resection in 3 cases and subtotal resection in 1 case with brainstem glioma. In control group,complete resection was achieved in 1 case and subtotal resection in 4 cases with trigeminal neurinoma, and complete resection in 7 cases and subtotal resection in13 cases with acoustic neuroma, and complete resection in 4 cases and subtotal resection in 10 cases with spinal meningioma, and subtotal resection in 3 cases with brainstem glioma. Except brainstem glioma due to its number of cases is too small,the data showed that the differences in tumor resection degree between the two methods had statistical significance(χ21=5.182,P1=0.023;χ22=5.182,P2=0.000;χ23=7.748,P3=0.005).2. The bleeding volume during operation:In test group, the average bleeding volume was 45±18.96 ml in the operation of parasagittal meningeoma,69±17.33 ml in sphenoid ridge meningioma,57±18.96 ml in olfactory groove meningioma, 67±23.41 ml in trigeminal neurinoma, 45±18.96 ml in acoustic neuroma, 27±7.48 ml in spinal meningioma,19±6.39 ml in brainstem glioma. In control group, the average bleeding volume was 152±42.84 ml in the operation of parasagittal meningioma,188±36.75 ml in sphenoid ridge meningioma, 132±42.84 ml in olfactory groove meningioma, 145±39.81 ml in trigeminal neurinoma, 102±42.84 ml in acoustic neuroma, 43±10.29 ml in spinal meningioma, 22±8.31 ml in brainstem glioma. Except brainstem glioma,the data showed that the bleeding volume between the two groups had statistical differences(t1=9.654,P1=0.000;t2=10.133,P2=0.000;t3=4.39,P3=0.001;t4=3.19,P4=0.004;t5=5.771,P5=0.000;t6=4.481,P6=0.000).3. Protection of nerves and blood vessels:3.1 In test group, 3 cases underwent repairation of superior sagittal sinus wall and 2cases underwent ligation of superior sagittal sinus during the operation of parasagittal meningeoma. The superior sagittal sinuses were identified free-flow in 31 cases and occlusion in 4 cases by MRV in postoperation. In the operation of sphenoid ridge meningioma, middle cerebral arteries occurring angiospasm in 2cases and angiostegnosis in one case were detected. In control group, 10 cases underwent repairation of superior sagittal sinus wall and 4 cases underwent ligation of superior sagittal sinus in the operation of parasagittal meningioma. The superior sagittal sinuses were identified free-flow in 21 cases and occlusion in 11 cases by MRV in postoperation. In the operation of sphenoid ridge meningioma,middle cerebral arteries occurring angiospasm in 5 cases and angiostegnosis in 4cases were detected. The data showed that protection of nerves and blood vessels between the two groups had statistical significance(χ21=7.316,P1=0.002;χ22=5.066,P2=0.024).3.2 In test group, the sense of smell was well protected in 8 cases with olfactory groove meningioma, but anosmia occurred in 6 cases. House-Brackmann grade I-II was achieved in 16 cases and grade III-VI in 7 cases with acoustic neurinoma.In control group, the sense of smell was well protected in 6 cases, but the sense ofsmell completely disappeared in 9 cases. House-Brackmann grade I-II was achieved in 7 cases and grade III-VI in 13 cases with acoustic neurinoma. The data showed that the differences in facial nerve protection between the two methods had statistical significance(χ21=5.137, P1=0.023)while those in olfactory nerve protection had no significance(χ22=0.852,P2=0.356).Conclusion: The contact laser could aid in improvement of tumor resection degree,protection of nerves and vessels for the patients with central nervous system tumors which were hard and closely adhesive with the surrounding nerves and vessels-venous sinus.