title: Flexible omnidirectional carbon dioxide laser as an effective tool for resection of brainstem, supratentorial, and intramedullary cavernous malformations.
abstract: BACKGROUND
  Lasers have a long history in neurosurgery, yet bulky designs and difficult ergonomics limit their use. With its ease of manipulation and multiple applications, the OmniGuide CO2 laser has reintroduced laser technology to the microsurgical resection of brain and spine lesions. This laser, delivered through a hollow-core fiber lined with a unidirectional mirror, minimizes energy loss and allows precise targeting.
  
  
  OBJECTIVE
  To analyze resections performed by the senior author from April 2009 to March 2013 of 58 cavernous malformations (CMs) in the brain and spine with the use of the OmniGuide CO2 laser, to reflect on lessons learned from laser use in eloquent areas, and to share data on comparisons of laser power calibration and histopathology.
  
  
  METHODS
  Data were collected from electronic medical records, radiology reports, operative room records, OmniGuide CO2 laser case logs, and pathology records.
  
  
  RESULTS
  Of 58 CMs, approximately 50% were in the brainstem (30) and the rest were in supratentorial (26) and intramedullary spinal locations (2). Fifty-seven, ranging from 5 to 45 mm, were resected, with a subtotal resection in 1. Laser power ranged from 2 to 10 W. Pathology specimens showed minimal thermal damage compared with traditionally resected specimens with bipolar coagulation.
  
  
  CONCLUSIONS
  The OmniGuide CO2 laser is safe and has excellent precision for the resection of supratentorial, brainstem, and spinal intramedullary CMs. No laser-associated complications occurred, and very low energy was used to dissect malformations from their surrounding hemosiderin-stained parenchymas. The authors recommend its use for deep-seated and critically located CMs, along with traditional tools.
authors.affiliation: *Department of Neurosurgery, Stanford Stroke Center and Stanford Institute for Neuro-Innovation and Translational Neurosciences, Stanford University School of Medicine, Stanford California; ‡Department of Pathology, Division of Neuropathology, Stanford University School of Medicine, Stanford California.
authors.forename: Omar
authors.initials: O
authors.lastname: Choudhri
authors.forename: Jason
authors.initials: J
authors.lastname: Karamchandani
authors.forename: Peter
authors.initials: P
authors.lastname: Gooderham
authors.forename: Gary K
authors.initials: GK
authors.lastname: Steinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001933:Brain Stem / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D002245:Carbon Dioxide; D054022:Cerebrum / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000601:surgery*; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D018583:Pliability; D012189:Retrospective Studies; D013116:Spinal Cord / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide