Utility of the CO2 Laser in the Microsurgical Resection of Cavernous Malformations
Utility of the CO2 Laser in the Microsurgical Resection of Cavernous Malformations
复制标题
DOI：
10.1016/j.wneu.2011.12.088
复制
发表时间：
2013-05-01
影响因子：
2
通讯作者：
Spetzler, Robert F.
中科院分区：
文献类型：
--
作者：
Consiglieri, Giac D.;Killory, Brendan D.;Spetzler, Robert F.
目的：CO2激光在神经外科中的应用历史悠久。然而，它的实用性受到其庞大的设计和与手术显微镜一起使用的挑战的限制。随着OmniGuide光纤的发展，一种通过柔性空心光子带隙镜传输光束的技术，现在可以更轻松和准确地手持和使用激光。方法：我们回顾性分析了前瞻性维护的数据库，以评估激光在23例连续患者中的效用（10名男性，13名女性;平均年龄，40.8岁;范围，9-64岁），患有海绵状血管畸形，由资深作者（R.F.S.）治疗。结果：4个病灶位于非功能区，13个位于脑干，4个位于脊髓，2个位于丘脑。激光的有用性被评为1至5级，5级被定义为“非常有帮助”。“平均效用评分为3.5 +/- 0.94（范围，2-5）。激光被认为在功能区进行皮质切除术和使海绵状畸形远离邻近含铁血黄素染色的组织时最有用。激光是无效的钙化，并在获得止血。CONCLUSIONS：CO2激光是一个有用的除了神经外科设备治疗病变的脑干，丘脑和脊髓。它的主要用途在于能够安全地进行集中的皮质切除术，并使海绵状畸形远离含铁血黄素染色的大脑。
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.