New technologies in neurosurgery: Effects on the conventional techniques and anaesthesiological considerations

Abstract

New technologies have been recently introduced into neurosurgery: laser sources, ultrasonic aspiration, intraoperative echotomography and intraoperative Doppler flowmeter. The aim of this work, showing the use of these instruments in different neurosurgical operations, is to discuss the effective improvements of the surgical techniques when comparing new and traditional technologies. The laser is able to concentrate high energies in restricted areas allowing a maximum selectivity. Having a superficial destructive effect with associated hemostasis, CO 2 and argon are suitable in dissection maneuvers. Nd:YAG produces a high thermal diffusion, consenting a deeper and extended tissue removal and a considerable reduction of intraoperative blood loss also in vascularized tumors. A promising field of application of the laser is the treatment of cerebral vascular malformations. In arterio-venous malformations the irradiation of the nidus with Nd:YAG produces a rapid obliteration of the pathologic vessels. This technique avoids the isolation of the feeding arteries and reduces the manipulation of the surrounding tissue. In small saccular aneurysms an argon laser is used to produce a shrinkage of the dilatation with consequent occlusion of the malformation. The ultrasonic aspirator is used in the tumoral surgery to obtain a more rapid demolition of the mass by fragmentation and suction. Intraoperative echotomography consents a sharp topographic localization of the lesion, particularly in deeper cerebral areas, providing data on the nature of solid tumors. The intraoperative Doppler flowmeter is useful for identification of the feeding arteries and the shunt of the small deep-seated arterio-venous malformations consenting a dynamic evaluation of the operation. General anaesthesia in neurosurgical procedures is favourably influenced by laser use. Conventional anaesthetic techniques, however, must be modified to avoid the harmful effect of the laser, depending on the movements of the brain surface, which may switch the laser beam to adjacent tissues, and become particularly dangerous when the laser is used near high functional structures or when the laser is driven by a computer.