Aura of technology and the cutting edge: a history of lasers in neurosurgery

Ryan, Robert W.; Spetzler, Robert F.; Preul, Mark C.

doi:10.3171/2009.6.focus09125

Cited by 53 publications

(52 citation statements)

References 32 publications

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“…The laser has both cutting and coagulating properties, 26,27 and when held farther from the surgical field the laser's coagulating properties can help control pial bleeding. The corpus callosum is generally not very vascularized, and with the addition of the laser there is only minimal bleeding during the procedure.…”

Section: 10mentioning

confidence: 99%

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%

Carbon dioxide laser for corpus callosotomy in the pediatric population

Choudhri¹,

Lober²,

Camara-Quintana³

et al. 2015

PED

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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%

“…Introduction of continuous-wave lasers with flexible hand-held fiber made lasers more useful in different field of neurosurgery [11][12][13][14]. 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].…”

Section: Introductionmentioning

confidence: 99%

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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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“…[2][3][4][5] Physicians and surgeons rapidly recognized the utility of lasers, since xenon arc-based photocoagulation of ophthalmic lesions had been developed in the previous decade. [6][7][8][9] For example, Zaret et al utilized a pulsed ruby laser to generate thermal injury in pigmented ocular tissues; retina and iris lesions were demonstrated in a rabbit model. 9 Goldman and Rockwell noted the utility of lasers for delivering light to confi ned regions on the order of a few micrometers.…”

Section: Introductionmentioning

confidence: 99%

Laser micro- and nanofabrication of biomaterials

Narayan

Goering

2011

MRS Bull.

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Over the past half century, rapid progress has been made in laser-based medical diagnosis and treatment as well as in laser-based medical device fabrication. Lasers have unique capabilities for coating, machining, melting, polymerizing, sintering, and welding materials that are used in implantable and transdermal medical devices. In this review, academic and industrial developments involving laser processing of materials for dental, orthopedic, neural, ophthalmic, cardiovascular, and transdermal applications are described. In addition, laser processing of nanoscale materials for medical applications is discussed. Finally, challenges associated with commercialization of laser biomaterials are considered. Due to the unique capabilities provided by laser-based processes, it is anticipated that the use of laser biomaterials in implantable and transdermal medical devices will markedly increase over the coming years.Roger Narayan, UNC/NCSU Joint Department of Biomedical Engineering , Raleigh , NC , USA ; roger_narayan@msn.com Peter Goering, Center for Devices and Radiological Health , U.S. Food and Drug Administration , Silver Spring , MD , USA ; peter.goering@fda.hhs. Edwards et al. described medical applications of free-electron lasers, which use light emitted by accelerated electrons. Infrared light emission from these lasers may be used for human neurosurgery, including treatment of metastatic brain tumors and ophthalmic surgery. 15 -19 They noted that use of a free-electron laser with 6.45 μ m emission for tissue ablation was correlated with minimal or undetectable collateral tissue damage. This wavelength is associated with brittle fracture at the commencement of explosive vaporization, mitigating damage to collateral tissues. Femtosecond pulsed lasers are currently used for LASIK (cornea refractive surgery); in this procedure, the laser is used to ablate a portion of tissue known as a lenticule from the cornea. 20 In addition, it is being considered for treatment of presbyopia (age-related vision changes) and for use in keratoplasty (cornea plastic surgery). Femtosecond laser surgeries involve two different modes. 21 Processing at low irradiance involves direct multiphoton interactions and free electron-induced chemical processes; at high irradiance, thermoelastic stresses may play signifi cant roles. Bashford described another use of lasers in medical therapy. In this approach, which is known as laser therapy, low intensity laser energy can be used to alter cellular function. This type of laser-tissue interaction may be used to treat neurological tissue, musculoskeletal tissue, and other soft tissues. 22 Laser processing of biomaterialsEfforts to examine laser-material interaction for biomedical device applications have largely paralleled efforts to examine laser-tissue interaction for clinical medical applications. Some of the earliest applications of lasers for processing synthetic biomaterials involved assessment of laser welding as an alternative to conventional investment soldering. As noted by Eliades e...

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Aura of technology and the cutting edge: a history of lasers in neurosurgery

Cited by 53 publications

References 32 publications

Carbon dioxide laser for corpus callosotomy in the pediatric population

Carbon dioxide laser for corpus callosotomy in the pediatric population

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

Laser micro- and nanofabrication of biomaterials

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