Use of flexible hollow-core CO2 laser in microsurgical resection of CNS lesions: early surgical experience.
BACKGROUND
The CO2 laser has a long history in both experimental and clinical neurosurgery. However, its use over the past decade has been limited by its cumbersome design and bulky set-up of the micromanipulator. These limitations are amplified when it is used with the operating microscope. These restrictions are addressed by the Omniguide fiber, which delivers the beam through flexible hollow-core photonic bandgap mirror fibers and allows the laser to be wielded like any other surgical instrument.


METHODS
The attending neurosurgeon prospectively assessed the usefulness of the laser in its first 45 consecutive uses at our institution based on a scale of 1 to 5.


RESULTS
The series included 11 cavernous malformations, 14 meningiomas, 7 ependymomas, 3 metastases, 3 astrocytomas, and 7 miscellaneous lesions. The laser was set up 91 times and used in 45 cases. The Omniguide fiber failed 5 times. No adverse events involving patients or staff were associated with laser use. The mean utility score was 3.7 +/- 0.8 (range, 2-5). The laser was most helpful in debulking fibrous lesions too tough for ultrasonic aspiration and lesions adherent to delicate neurovascular structures. The laser was not helpful with highly vascular tumors.


CONCLUSIONS
In our early experience, the Omniguide laser was very helpful in selected cases in resecting specific types of lesions without complications; we have added the device to our neurosurgical armamentarium.
Killory
Brendan D
BD
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Chang
Steve W
SW
Wait
Scott D
SD
Spetzler
Robert F
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult