A new 1.9-mu wavelength laser for neurosurgery.
The 1.9-mu wavelength component of a 1.9/1.06-mu two-wavelength laser with near-continuous wave properties was tested for its potential use in neurosurgery. The 1.9-mu wavelength has tissue-ablative capabilities, while the 1.06-mu wavelength (Nd:YAG) is suitable for achieving hemostasis. The advantages of the 1.9-mu wavelength over the CO2 laser include its ability to transmit through silica fiberoptic delivery systems and its deeper penetration in water (approximately 100 mu, a depth 10 times greater than for the CO2 laser), which is compatible with irrigation during ablation. To test the effectiveness of the laser, bilateral craniotomies were performed in anesthetized rats immobilized in a stereotactic frame. Under an operating microscope, lesions were made on the cortex by delivering the 1.9-mu laser beam through a 400-mu fiber at an average power of 1 W over a range of fluences. Subjective intraoperative observations were notable for minimal bleeding, absence of charring when the tissue was irrigated with a thin stream of saline, and uniform lesion formation. For comparison, lesions were generated with a commercially available continuous-wave CO2 laser at equivalent power and fluences. Histological specimens were divided into three groups based on the study after laser application: acute (30 minutes), subacute (48 hours), and chronic (14 days). The extent of thermal injury for the 1.9-mu laser in the acute lesions was quantitatively and histologically similar to that generated by the CO2 laser. Regions of injury extended approximately from the apex of the lesion, and crater depths generated by both lasers were similar (250 to 750 mu) in the range of fluences investigated (1.25 to 10 kJ/sq cm). Subacute and chronic histological specimens demonstrated inflammatory and repair responses that correlated with the acute injury regions in both the 1.9-mu and CO2 laser-treated specimens. This study demonstrates a neurosurgical potential for a new two-wavelength laser that ablates tissue effectively with limited thermal injury. The 1.9-mu laser is comparable to the widely used CO2 laser but offers several unique advantages, including the ability for delivery through a fiberoptic system and to irrigate tissue during use.
Department of Surgery (Neurosurgery), Massachusetts General Hospital, Harvard Medical School, Boston.
J D
JD
Steichen
R B
RB
Stewart
D N
DN
Louis
B B
BB
Choi
R
R
Kung
R L
RL
Martuza
D000818:Animals; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy; D053685:Laser Therapy / Q000009:adverse effects; D051381:Rats; D013997:Time Factors