Observations on the use of three laser sources in sequence (co₂‐argon‐nd: yag) in neurosurgery

Abstract

In neurosurgical practice the laser can be considered an additional instrument to improve conventional techniques, or even a new method of treatment of some cerebral lesions. A complete laser surgery requires the association of three laser sources in combination. The CO2 laser is useful for cutting small lesions in important brain areas. Nd: YAG is particularly suitable for tumor surgery--allowing a deeper destruction with predictable effects associated with a more complete hemostasis. The combination Nd: YAG-Argon has clear indications for irradiation of the vessels.

Comparison of a high power diode laser with the Nd:YAG laser using in situ wound strength analysis of healing cutaneous incisions

“…Photoablation of ureteral and renal pelvis carcinomas using the Nd:YAG has also been reported [15,16]. In the field of neurosurgery, the Nd:YAG has been used in operating intracranial tumors and cranial and spinal arteriovenous malformations [17][18][19][20][21]. Although it is an effective instrument for hemostatic tissue ablation, the Nd:YAG tends to be cumbersome in design and operation.…”

Beneficial Use of a New Hand-Held CO2 Laser Fiber in Resection of a Calcified and Vascular Intraventricular Tumor

“…Despite these innovative attempts, a laser with acceptable surgical dexterity that is absorbed by neural tissue and CO 2 wavelengths has not yet been introduced. Some researchers have resigned to the truth that laser use in neurosurgery requires the combination of separate laser energies, with CO 2 for precision and Nd:YAG for maneuverability (3,17,18).…”

“…Neurosurgeons' interest in laser technology peaked in the early 1980s (39,44), when the surgical laser was heralded as a dynamic instrument capable of noncontact precision cutting, hemostasis, and vaporization with reduced mechanical trauma, blood loss, and operative time (1-3, 10, 14, 23, 30, 44, 46). This enthusiasm has waned over time (30), as the progression of laser technology in neurosurgery has been limited by the poor maneuverability of carbon dioxide (CO 2 ) lasers and the propensity of other laser energies to cause collateral thermal injury (3,8,14,17,21,32,37). With the advent of a dielectric omnidirectional reflector and phototonic bandgap optical fibers, the CO 2 surgical laser can now be used as a low-profile hand-held device with considerable dexterity.…”

Current status of lasers in neurosurgical oncology

“…Further pioneering efforts by Heppner and Ascher [3], Ascher [4], Ascher and Cerullo [5], and Takizawa [6] were responsible for the popularization of the use of the carbon dioxide laser in neurosurgical practice. Clinical applications for removal of central nervous system (CNS) neo-plasms were outlined by Powers et al [7], Edwards and Boggan [S], and Fasano [9] for the argon laser and by Beck [10,11] and Takeuchi et al [12] for the neodymium:YAG laser. These three lasers, particularly the carbon dioxide laser, have been used for the photothermal ablation of critically placed CNS tumors.…”