title: Application of a flexible CO(2) laser fiber for neurosurgery: laser-tissue interactions.
abstract: OBJECTIVE
  The CO(2) laser has an excellent profile for use in neurosurgery. Its high absorption in water results in low thermal spread, sparing adjacent tissue. Use of this laser has been limited to line-of-sight applications because no solid fiber optic cables could transmit its wavelength. Flexible photonic bandgap fiber technology enables delivery of CO(2) laser energy through a flexible fiber easily manipulated in a handheld device. The authors examined and compared the first use of this CO(2) laser fiber to conventional methods for incising neural tissue.
  
  
  METHODS
  Carbon dioxide laser energy was delivered in pulsed or continuous wave settings for different power settings, exposure times, and distances to cortical tissue of 6 anesthetized swine. Effects of CO(2) energy on the tissue were compared with bipolar cautery using a standard pial incision technique, and with scalpel incisions without cautery. Tissue was processed for histological analysis (using H & E, silver staining, and glial fibrillary acidic protein immunohistochemistry) and scanning electron microscopy, and lesion measurements were made.
  
  
  RESULTS
  Light microscopy and scanning electron microscopy revealed laser incisions of consistent shape, with central craters surrounded by limited zones of desiccated and edematous tissue. Increased laser power resulted in deeper but not significantly wider incisions. Bipolar cautery lesions showed desiccated and edematous zones but did not incise the pia, and width increased more than depth with higher power. Incisions made without using cautery produced hemorrhage but minimal adjacent tissue damage.
  
  
  CONCLUSIONS
  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.
authors: Neurosurgery Research Laboratory, Division of Neurological Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors: Robert W
authors: RW
authors: Ryan
authors: Tamir
authors: T
authors: Wolf
authors: Robert F
authors: RF
authors: Spetzler
authors: Stephen W
authors: SW
authors: Coons
authors: Yoel
authors: Y
authors: Fink
authors: Mark C
authors: MC
authors: Preul
mesh_terms: D000818:Animals; D002425:Cautery / Q000379:methods; D002540:Cerebral Cortex / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D003890:Desiccation; D004487:Edema / Q000209:etiology; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation / Q000379:methods*; D005904:Glial Fibrillary Acidic Protein / Q000378:metabolism; D007150:Immunohistochemistry; D054020:Lasers, Gas / Q000627:therapeutic use*; D008855:Microscopy, Electron, Scanning; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D010784:Photomicrography; D010841:Pia Mater / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D013552:Swine
chemical_list: D005904:Glial Fibrillary Acidic Protein