gms | German Medical Science

Objective: Neuroendoscopy is presently considered a minimally invasive surgical approach. Neuroendoscopic biopsy of tumours growing in the ventricle is considered a safe procedure. Despite wonderful magnification of the endoscope, due to the minimally surgical approach bleeding control and tumour ablation are harmful by usual tools. Most of the currently available laser systems in neurosurgery (Nd YAG, diode laser) have high peak energy and may create mechanical side effects in proximity to vital structures.

Methods: We have used a recently developed Tu diode pumped solid state (DPSS) laser (Revolix, LISA laser products). The active laser material is thulium (Tu), emitting lightat wavelength of 2,0 micron, through one microfiber of 0,2 mm diameter. This small fibre can pass in the working channel, too. The energy by water can be absorbed without side effects. The laser can hit the tumor in near contact or targeting from short distance with limited penetration. We report our experience in 4 ventricular malignant tumours undergoing neuroendoscopic biopsies and partial resection.

Results: In the ventricular tumours biopsy laser fibre via STORZ flexible endoscope was used for haemostasis and limited ablation. In one case septostomy through infiltrated septum was successfully performed. In one case 3^rd ventricular nodule was totally removed by cutting and ablation with the laser. In all surgical procedures bleeding control was easy and successful. During laser activation endoscopic vision was always clear. No side effects due to this laser were observed.

Conclusions: We consider Tu DPSS laser extremely handle and safe. Based on our experience this laser can be considered a valid tool for coagulation and tissue ablation in ventricular neuroendoscopy.