Application of underwater shock wave and laser-induced liquid jet to neurosurgery

Abstract

Paper deals with applications of underwater shock waves to medicine. A historical development of underwater shock wave generation by using pulsed Ho:YAG laser beam irradiation in water is briefly described and an overview is given regarding potential applications of shock waves to neuro-surgery. The laser beam irradiation in a liquid-filled catheter produces water vapor bubble and shock waves intermittently produces micro-liquid jets in a controlled fashion from the exit of the catheter. Correlations between shock dynamics and bubble dynamics are emphasized. To optimize the jet motion, results of basic parametric studies are briefly presented. The liquid jet discharged from the catheter exit has an impulse high enough to clearly exhibit effectiveness for various medical purposes. In liquid jets we observed reasonably strong shock waves and hence invented a compact shock generator aiming to apply to microsurgery. We applied it to a rat's bone window and developed an effective method of brain protection against shock loading. The insertion of Gore-Tex® sheet is found to attenuate shock waves drastically even for very short stand off distance and its physical mechanism is clarified. The laser-induced liquid jet (LILJ) is successfully applied to soft tissue dissection. Animal experiments were performed and results of histological observations are presented in details. Results of animal experiments revealed that LILJ can sharply dissect soft tissue with a minimum amount of liquid consumption, while blood vessels larger than 0.2 mm in diameter are preserved. Shock waves and LILJ have a potential to be indispensable tools in neuro-surgery.