Application of a flexible CO2 laser fiber for neurosurgery: laser-tissue interactions

Ryan, Robert W.; Wolf, Tamir; Spetzler, Robert F.; Coons, Stephen W.; Fink, Yoel; Preul, Mark C.

doi:10.3171/2009.7.jns09356

Cited by 58 publications

(67 citation statements)

References 26 publications

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“…This tool has properties of sufficient penetrability and high absorption in water, allowing clean pial incisions with minimal desiccated and edematous areas, as observed in comparison histological specimens treated with bipolar electrocautery. 27 We have been able to perform diffusion tensor imaging on some of our laser callosotomy patients, with results that demonstrate a clean accurate section of callosal fibers (Fig. 4).…”

Section: 10mentioning

confidence: 99%

“…2,3,8,24,[29][30][31] Argon and Nd:YAG (neodymium:yttrium-aluminumgarnet) lasers have been used in neurosurgical operating rooms in the past, but because of their high penetration and collateral tissue damage they failed to gain popularity. 27 The CO 2 laser, however, has favorable features such as absorption by water and minimal thermal penetration. These properties allow its use for varied applications, such as tumor resection, cord detethering, dural closure, and vascular anastomoses.…”

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confidence: 99%

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Carbon dioxide laser for corpus callosotomy in the pediatric population

Choudhri¹,

Lober²,

Camara-Quintana³

et al. 2015

PED

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OBJECT The authors describe the application of a flexible CO2 laser for corpus callosotomy in children with epilepsy. METHODS This retrospective case series reviews all cases in which pediatric patients underwent a corpus callosotomy performed using the CO2 OmniGuide laser between May 2005 and October 2012. Data were collected from 8 corpus callosotomy procedures in 6 pediatric patients presenting with medically refractory epilepsy marked by drop attacks. RESULTS Complete corpus callosotomies were performed in 6 patients (3 boys, 3 girls; ages 5–14 years). In 4 patients the complete callosotomy occurred as a single procedure, and in 2 patients an anterior two-thirds callosotomy was performed first. These 2 patients subsequently required a complete callosotomy due to inadequate control of their drop attacks. In all cases there was clean lesioning of the tract with preservation of the ependymal plane and less inadvertent thermal tissue damage due to low penetration of the laser through cerebrospinal fluid. All patients had resolution or improvement of drop attacks after surgery. No complications were encountered, and imaging demonstrated a clean sectioning of callosal fibers with preservation of normal ventricular anatomy. CONCLUSIONS These cases illustrate the use of this device in completing corpus callosotomy in pediatric patients. The low-profile laser fiber tip was well suited for working in the depths of the interhemispheric fissure with minimal brain retraction. The flexible CO2 laser allows a precise callosal lesioning through an interhemispheric approach and is a useful adjunct to be employed in these cases.

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Section: 10mentioning

confidence: 99%

mentioning

confidence: 99%

Carbon dioxide laser for corpus callosotomy in the pediatric population

Choudhri¹,

Lober²,

Camara-Quintana³

et al. 2015

PED

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“…At the 980-nm wavelength, m A (H 2 O) = 0.45 cm it has several technical and cost disadvantages, which prevent it from being broadly used (Table 2). 14,16 In addition, the 980-nm laser is well absorbed by both water and hemoglobin, which makes it a versatile tool for a broad range of applications. Another advantage is that the 980-nm light is more absorbed than the 1064-nm light by both oxy-and deoxyhemoglobin.…”

Section: 418mentioning

confidence: 99%

Application of a 980-nanometer diode laser in neuroendoscopy: a case series

Reis

Teixeira

Mancini³

et al. 2016

JNS

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V entricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. About 30% of patients with hydrocephalus meet the criteria for this technique, which may prevent the need for a ventriculoperitoneal shunt, resulting in reduced costs and low incidence of late complications. 4,5,6,7,12,15,17 Nonetheless, because a ventricular endoscope is used through a single bur hole, additional resources to enable cutting, coagulation, and ablation of injuries are extremely relevant to reduce surgical time and hospital length of stay, and increase the safety of the procedure and the patient's postoperative comfort. 8,10,18 Increasing experience in several centers has proven that laser-assisted endoscopic procedures are useful options, because they are safe, effective, and advantageous in cases of distorted anatomy. 4,18 We have previously shown favorable results of surgical Nd:YAG and therapeutic laser (diode 685 nm) in neuroendoscopic procedures, such as excision of colloid cysts and myelomeningocele repair. 10,11 Furthermore, the use of 980-nm diode laser in brain tissue of Wistar rats has been tested in recent studies and was associated with a remarkable ablating capacity, minimal thermal damage to surrounding tissue, and lower recovery time than other lasers with different wavelengths or electrocoagulators. The 980-nm-wavelength diode laser provides proper absorption in both water and hemoglobin, which is an adabbreviatioNs μ A (H 2 O) = absorption coefficient of water; CW = continuous wave; ETV = endoscopic third ventriculostomy. obJective Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. Highpower (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases. methods Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and followup were recorded. results Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24-48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation. coNclusioNs The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.

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“…The most using approach on brain tumors and VS operated through middle fossa [11,13,8,20,10,[21][22][23][24][25][26]. Our own experience with 2µ-Thulium hand-held laser fiberin intracranial tumor surgery have been the rationale for applying this tool in "key hole" retrosigmoid removal of VS.…”

Section: Introductionmentioning

confidence: 99%

“…Its superiority comes from avoidance of the explosive effects of pulsed-wave lasers and accurate cutting and vaporization by using focused beams, without the need to handle or retract the tissue [15]. At first introduction of flexible CO 2 laser fibers offered the possibility of guiding the laser beam by small and variable hand-held devices [9,12,13,[16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

Mastronardi

Cacciotti

Roperto

et al. 2016

Caspian.J.Neurol.Sci

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Background: Vestibular Schwannoma (VS) is one of the skull base tumors originating from vestibular portion of eighth cranial nerve. Recently, 2 microThulium laser is used in the surgery of some intracranial tumors. Objectives: Assessing the efficacy of 2 micro-Thulium flexible hand-held laser fiber (Revolixjr ® ) in microsurgical removal of VS. Materials and Methods:This retrospective non-randomized study was carried out from July 2012 to November 2015. 39 patients with VS had been operated on with microsurgical technique via retro-sigmoid approach. 2 micro-Thuliumfiber hand-held flexible laser was used for tumor resection in 39 cases. Facial nerves function by House-Brackmann (HB) scale and hearing state were assessed preoperatively and 1 week and 6-month postoperatively. Results: Overall time of surgery changed only in proportion with the size of tumor (185-575 minutes) and was not affected by the use of laser. In 5out of 39cases, preoperative facial nerve palsy HB2, and in one case HB4 (permanent) was observed. On considering 38 cases, at 6-month follow-up facial nerve preservation rate (HB1) was 92.1% (from May 2015 all patients had not postoperative facial palsy). Hearing preservation rate was possible in 12 out of 15 cases with previously acceptable preoperative hearing state (AAO-HNS A and B classes). The mean surgeon satisfaction rate of usefulness of this technic was 2.7 in a 0-3-scale Conclusions: A good functional outcome including facial nerve preservation and hearing preservation was obtained by micro-Thulium-fiber hand-held flexible laser microsurgery.

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Application of a flexible CO2 laser fiber for neurosurgery: laser-tissue interactions

Abstract: The photonic bandgap fiber CO(2) laser produced reliable cortical incisions, adjustable over a range of settings, with minimal adjacent thermal tissue damage. Ease of application under the microscope suggests this laser system has reached true practicality for neurosurgery.

Cited by 58 publications

References 26 publications

Carbon dioxide laser for corpus callosotomy in the pediatric population

Carbon dioxide laser for corpus callosotomy in the pediatric population

Application of a 980-nanometer diode laser in neuroendoscopy: a case series

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

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