gms | German Medical Science

61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Efficacy and safety of the 2micron continuous wave laser in neuro-endoscopic procedures

Meeting Abstract

  • Christoph Nagel - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland
  • Florian Heinrich Ebner - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland
  • Marcos Soares Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland
  • Martin Ulrich Schuhmann - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1697

DOI: 10.3205/10dgnc168, URN: urn:nbn:de:0183-10dgnc1685

Veröffentlicht: 16. September 2010

© 2010 Nagel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The 2micron continuous wave laser combines the high tissue effectiveness of the CO2 laser (but can be applied through a fiber as contact laser, with a maximal effective distance of 1–2 mm under water) with the hemostatic capacity of the Nd:YAG laser, however with a maximal tissue penetration of 1–2 mm. This seems to render the laser useful for intraventricular neuro-endoscopy. We report on our experiences in a prospective consecutive series of pediatric and adult patients.

Methods: Within 8 months the laser was used in 34 neuro-endoscopic intraventricular procedures, performed in 14 children and 16 adults. The laser fibre was used as a contact device, it was advanced through the working channel and used for all fenestrations, tissue shrinkage and hemostasis as needed.

Results: In obstructive hydrocephalus we performed 19 primary ETVs and one repeat ETV. In addition we performed 3 septostomies, 2 cyst fenestrations plus shrinkage-remodeling of third ventricular floor in large suprasellar arachnoid cysts, removal of 1 colloid cyst, fenestration of 1 intraventricular cyst, 2 fenestrations of mid brain cysts, and 1 cysto-ventriculostomy of a frontal parenchymal cyst. In 4 tumour biopsies the laser was used for hemostasis only. In all fenestrations the laser totally replaced mechanically penetrating, cutting, and dilating devices. Regarding hemostasis the additional use of monopolar or bipolar coagulation was never necessary. There was no intra-operative unintended vascular injury and no clinically detectable hypothalamic/pituitary dysfunction post-operatively. In a girl with fenestration of multiple mid brain cysts the pre-existent oculomotor dysfunction was augmented post-operatively, the hemiparesis improved. In one ETV patient, the post-op routine CT scan detected hemorrhage within the basal cisterns, despite no detectable intra-operative bleeding. Operative time in general was not longer compared to non-laser neuro-endoscopy.

Conclusions: The 2micron laser seems to be ideally suited for intraventricular neuro-endoscopy, since it enables save and fast fenestrations without the necessity to change to any other instrument in most cases. Hemostatic capacity is very good. Due to its minimal effective distance within water and the low tissue penetration, it is safe regarding injury to cisternal arteries or neighboring structures like pituitary stalk or fornix. Compared to mechanical devices it is much better suited to perform fenestration from a steep angle and into floppy walls.