Ahead of Print: CO2 Laser for Cavernous Malformation Resections

Screen Shot 2013-11-04 at 1.54.10 PMBackground: 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 using 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 5-45 mm, were resected, with a subtotal resection in 1. Laser power ranged from 2-10 W. Pathology specimens showed minimal thermal damage compared to traditionally resected specimens with bipolar coagulation.

Conclusion: The OmniGuide CO2 laser is safe and has excellent precision for 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.

From: Flexible Omni-Directional Carbon Dioxide Laser as an Effective Tool for Resection of Brainstem, Supratentorial and Intramedullary Cavernous Malformations by Choudhri et al.

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