The Utility of Thulium Laser in Neuroendoscopy

Abstract

In the last years, neuroendoscopy has gained consensus as a minimally invasive surgical approach to ventricular lesions. The magnification of the endoscope has become wonderful, but the bleeding control and tumor ablation continue to be harmful by standard tools only through the working channel. Specially, in vascularized tumors and near vital structures the traditional electrosurgery can be ineffective and dangerous. Since 2009, we are using the Tu diode pumped solid state (DPSS) laser (Revolix, LISA laser products) to improve neuroendoscopic procedures. In the Tu DPSS laser the active material is thulium (Tu), emitting light at wavelength of 2,0 μ, through one microfiber large 0,2 mm in diameter introduced in the endoscope working channel. The Tu DPSS laser works very well in water solution, as in the CSF of the ventricles. This laser can hit the tumor by touching or targeting from short distance with low penetration. Tumor cutting and ablation is possible, too. We report our experience in 26 ventricular tumors, 16 in 3rd ventricle and 10 in the lateral ventricle. The histology was: 13 high grade glioma, 5 craniopharyngiomas, 2 PNET, 2 metastasis, 4 colloid cysts. A flexible or rigid scope was used. In 18 neuroendoscopic biopsies the Tu DPSS laser microfiber was used for hemostasis and partial ablation. In 5 craniopharyngiomas wall ablation was performed. In 4 colloid cysts complete removal was possible in one case 3rd ventricular nodule was totally removed by Tu laser ablation. The ETV or tumors cyst fenestration or septostomy through infiltrated septum was successfully performed. The Tu laser showed precise coagulation at low temperature without tissue sticking. In all surgical procedures bleeding control was easy and successful. During Tu laser activation endoscopic vision was always clear. No side effects due to this device were observed. We consider Tu DPSS laser extremely handle and safe. The Tu laser is very efficient for coagulation and ablation of vascularized tumors.