title: Utility of the CO2 laser in the microsurgical resection of cavernous malformations.
abstract: OBJECTIVE
  The CO2 laser has a long record of use in neurosurgery. However, its utility has been limited by its bulky design and the challenge of using it with the operating microscope. With the development of the OmniGuide fiber, a technology that delivers the beam through flexible hollow-core photonic bandgap mirrors, the laser can now be held and used with greater ease and accuracy.
  
  
  METHODS
  We retrospectively analyzed a prospectively maintained database to assess the utility of the laser in 23 consecutive patients (10 male, 13 female; mean age, 40.8 years; range, 9-64 years) with a cavernous malformation treated by the senior author (R.F.S.).
  
  
  RESULTS
  Four lesions were located in noneloquent areas, 13 were in the brain stem, four were in the spinal cord, and two were in the thalamus. The usefulness of the laser was rated on a scale of 1 to 5, with 5 defined as "extremely helpful." The mean utility score was 3.5 ± 0.94 (range, 2-5). The laser was judged most useful in creating cortisectomies in eloquent areas and in "shrinking" cavernous malformations away from adjacent hemosiderin-stained tissue. The laser was ineffective against calcification and in obtaining hemostasis.
  
  
  CONCLUSIONS
  The CO2 laser is a useful addition to the neurosurgical armamentarium for treating lesions in the brainstem, thalamus, and spinal cord. Its primary utility lies in its ability to create focused cortisectomies safely and to shrink cavernous malformations away from eloquent hemosiderin-stained brain.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Giac D
authors.initials: GD
authors.lastname: Consiglieri
authors.forename: Brendan D
authors.initials: BD
authors.lastname: Killory
authors.forename: Rasha S
authors.initials: RS
authors.lastname: Germain
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D020295:Brain Stem Neoplasms / Q000601:surgery; D002540:Cerebral Cortex / Q000601:surgery; D002648:Child; D004867:Equipment Design; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013786:Thalamic Diseases / Q000601:surgery; D055815:Young Adult