Laser-assisted neuroendoscopy using a neodymium-yttrium aluminum garnet or diode contact laser with pretreated fiber tips

OBJECT: Although lasers have proved to be valuable in neuroendoscopy, surgeons are still not comfortable using high-energy laser endoscopic probes in proximity to vital structures such as the basilar artery in third ventriculostomy. The authors have developed a special laser catheter for use in neuroendoscopy; the object of this paper is to present their experimental and clinical experiences using the catheter.

METHODS: This laser catheter is fitted with an atraumatic ball-shaped fiber tip that is pretreated with a layer of carbon particles. These carbon particles absorb approximately 90% of the energy emitted, which is very effectively converted into heat. As the heat is generated in this very thin layer of carbon coating, the temperature at the surface of the ball-shaped tip reaches ablative temperatures instantly at powers of only a few watts per second, which has enabled the authors to limit drastically the amount of laser light used and the length of exposure needed, thereby increasing safety even around critical structures.

CONCLUSIONS: The authors present experimental data and their clinical experience using these pretreated fiber tips with a neodymium-yttrium aluminum garnet contact laser or a diode contact laser in 49 patients (22 males and 27 females) and a variety of procedures: third ventriculocistemostomy (33 patients), cyst fenestration (nine patients), colloid cyst resection (six patients), and fenestration of the septum pellucidum (one patient). There was no instance of mortality or increased morbidity. To date, the procedure success rate is 100% and the overall outcome success rate is 86%. The authors conclude that pretreated atraumatic ball-shaped fiber tips now make laser application safe and effective in a variety of neuroendoscopic procedures. Because of their low power range (only several watts), compact diode lasers will be the energy source of first choice.