title: Utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery.
abstract: BACKGROUND
  This study sought to report on the utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery.
  
  
  METHODS
  A retrospective chart review identified 16 patients who underwent laser-assisted transsphenoidal surgery. All tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications, and resection rates.
  
  
  RESULTS
  Sixteen pituitary lesions (pituitary adenomas, 12; Rathke cleft cyst, 2; pituitary cyst and craniopharyngioma, 1 each) with an average size of 22.7 mm were identified by radiographic and pathologic criteria. All patients underwent flexible-fiber CO2 laser-assisted endoscopic endonasal transsphenoidal surgery. Of the adenomas, 8 were nonsecreting and 4 were secreting (3 prolactinomas and 1 ACTH secreting). Gross total resection was achieved in 7 of 16 patients (43.75%) with hormone remission in all patients (100%) after a mean follow-up of 19.3 months. Postoperative complications occurred in 3 patients (18.75%): 2 patients developed transient diabetes insipidus (DI) and 1 developed a CSF leak requiring surgical repair. Five patients (31.25%) underwent postoperative radiation to the residual lesions.
  
  
  CONCLUSIONS
  We found that CO2-laser-assisted endoscopic endonasal transsphenoidal surgery for sellar tumors is a minimally invasive approach using a tool that is quick and effective at cutting and coagulation. The surgery has a low rate of complication, and no laser-related complications were encountered. The laser fiber allows the surgeon to safely cut and coagulate without the line-of-sight problems encountered with conventional CO2 lasers. Further studies are recommended to further define its role in endoscopic endonasal sellar surgery.
authors.affiliation: Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA.
authors.forename: Mayur
authors.initials: M
authors.lastname: Jayarao
authors.forename: Anand K
authors.initials: AK
authors.lastname: Devaiah
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Chin
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation*; D054020:Lasers, Gas; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D055100:Optical Fibers; D010907:Pituitary Hormones / Q000097:blood; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D015175:Prolactinoma / Q000473:pathology / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D010907:Pituitary Hormones