title: Beneficial use of a new hand-held CO2 laser fiber in resection of a calcified and vascular intraventricular tumor.
abstract: BACKGROUND
  The progression of laser technology in neurosurgery has been limited by the poor maneuverability of traditional line-of-sight carbon dioxide (CO2) lasers and the propensity of other laser energies to cause collateral thermal injury to adjacent neural structures. The advent of a dielectric omnidirectional reflector and the subsequent development of phototonic bandgap fibers (PBF) have transformed the CO2 laser into a low-profile instrument with considerable dexterity and many potential new neurosurgical applications.
  
  
  METHODS
  A 48-year-old woman presented with a large mass in the left lateral ventricle that was first diagnosed>20 years ago. The patient was asymptomatic until 1 month before presentation, when she began to experience progressive memory loss and neurocognitive decline.
  
  
  RESULTS
  The hand-held CO2 laser was used to debulk the tumor. The CO2 laser vaporized neoplastic cellular material and simultaneously cauterized microvascular structures.
  
  
  CONCLUSIONS
  The CO2 laser was exceptionally useful in the resection of this long-standing and extremely calcified, yet vascular mass. A review of the evolution of laser technology applications in neurosurgery is presented, with a specific focus on the innovations that led to the development of the new PBF CO2 laser. This new technology may be advantageous in tumor surgery, particularly in the resection of long-standing calcified and vascular tumors that are not amendable to traditional surgical techniques.
authors: Department of Neurosurgery, Columbia University Medical Center, Columbia University, College of Physicians & Surgeons, New York City, New York, USA. hrm2104@columbia.edu
authors: Hani R
authors: HR
authors: Malone
authors: Omar N
authors: ON
authors: Syed
authors: Anthony L
authors: AL
authors: D'Ambrosio
authors: Guy M
authors: GM
authors: McKhann
mesh_terms: D002114:Calcinosis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D054020:Lasers, Gas; D020547:Lateral Ventricles / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D009460:Neurologic Examination; D020288:Papilloma, Choroid Plexus / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed