Beneficial Use of a New Hand-Held CO2 Laser Fiber in Resection of a Calcified and Vascular Intraventricular Tumor
Beneficial Use of a New Hand-Held CO2 Laser Fiber in Resection of a Calcified and Vascular Intraventricular Tumor
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DOI：
10.1016/j.wneu.2011.04.031
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发表时间：
2012-07-01
影响因子：
2
通讯作者：
McKhann, Guy M., II
中科院分区：
文献类型：
--
作者：
Malone, Hani R.;Syed, Omar N.;McKhann, Guy M., II
背景：传统的视线二氧化碳(CO2)激光的可操作性差，以及其他激光能量容易对邻近的神经结构造成附带的热损伤，限制了激光技术在神经外科的发展。介电全向反射器的出现和随后光致带隙光纤(PBF)的发展使CO2激光器变成了一种相当灵巧的低调仪器，并有许多潜在的新的神经外科应用。病例描述：一名48岁的女性患者，20年前首次被诊断为左侧脑室巨大肿块。直到出现症状前1个月，患者一直没有症状，这时她开始经历进行性记忆丧失和神经认知能力下降。结果：手持二氧化碳激光被用来揭开肿瘤。CO2激光汽化肿瘤细胞物质，同时烧灼微血管结构。结论：在切除这个长期存在且极度钙化的血管肿块时，CO2激光特别有用。回顾了激光技术在神经外科中的应用进展，重点介绍了导致新型PBF CO2激光器发展的创新。这项新技术可能在肿瘤外科手术中具有优势，特别是在切除长期存在的钙化和血管肿瘤方面，这些肿瘤是传统外科技术无法修正的。
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.CASE DESCRIPTION: 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.