Introduction: Meningiomas are the most common primary central nervous system neoplasm in the United States, while Intraventricular meningiomas (IVMs) are rare (0.5-5%) and usually low-grade (90% grade I) as well as meningiomatosis (presence of at least 2 lesions that appear simultaneously or not, at different intracranial locations) which accounts for < 10% of cases. In this study we describe our preliminary experience with the use of CO2 laser ablation in rare meningioma subtypes. The technique was implemented using piezoelectric to perform craniotomies.
Methods: 5 cases in the last two years were retrospectively reviewed and divided according to the location and the meningioma subtype; clinical-radiological findings, recurrence rate, surgical technique and radicality were analyzed. In all cases a CO2 laser system with a radiofrequency-excited laser source, a surgical scanner, and a high-precision micromanipulator, connected to the surgical microscope was used.
Results: 3 out 5 cases included intraventricular meningiomas (2 left trigonal and 1 right trigonal meningioma with peritrigonal extension): gross total resection was achieved in all cases.
2 patients with meningiomatosis were treated with resection of the major symptomatic lesion (2 right-sided sphenoid wing meningiomas with optic nerve compression). The CO2 laser was used together with the traditional instruments in every step of the procedures (early debulking, progressive tumor removal, and, lastly, for surgical cavity hemostasis). The laser system is able to cut and coagulate the tissue simultaneously although it can be time consuming. None of the patients experienced major complications nor permanent neurological deficits. No injury to the surrounding neurovascular structures was observed. Postoperative neuroimaging confirmed complete tumor removal and showed a marked reduction of preoperative surrounding edema without signs of cerebral contusions.
Conclusions: Our preliminary experience demonstrates that, in selected cases and surgical phases, the use of laser ablation could represent an additional and safe option, along with traditional surgical tools, for local control of progressive meningiomas, even in locations that are challenging to access surgically.