Contact laser-assisted neuroendoscopy can be performed safely by using pretreated 'black' fibre tips: experimental data.
OBJECTIVE
Laser-assisted endoscopic neurosurgery by using conventional fibres requires the use of high-power laser light. Because this is potentially hazardous, we developed a pretreated fibre tip and evaluated tissue effects in vitro and in vivo.


METHODS
By applying a highly absorbing coating to the front of the ball tip, almost all laser light is transformed into thermal energy, instantly producing ablative temperatures at the tip itself. The temperature distribution was examined by using an in vitro thermal imaging technique. The in vivo effect on rabbit cerebral tissue was examined macroscopically and histologically.


RESULTS
By using a conventional fibre tip, ablation was not observed, despite the use of high energy and power (20 W for 10 seconds), whereas histology and thermal imaging demonstrated deleterious effects deeply into the cerebral tissue. By using the coated fibre tip, ablation was observed at low energy and power (1 W for 1 second) with thermal effects restricted to superficial structures.


CONCLUSIONS
We show that laser-assisted neuroendoscopy can only be considered to be safe when pretreated "black" fibre tips are used, as laser light damages deep structures.
Willems
P W
PW
Department of Neurosurgery, University Hospital Utrecht, Utrecht, The Netherlands.
Vandertop
W P
WP
Verdaasdonk
R M
RM
van Swol
C F
CF
Jansen
G H
GH
D000818:Animals; D001921:Brain / Q000601:surgery*; D002404:Catheterization; D004724:Endoscopy; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D011817:Rabbits