Complications of use of the neodymium: yttrium-aluminum-garnet laser in neurosurgery.

Review of the clinical records of 32 patients who underwent operation for brain tumors with the use of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser during a 4-month period revealed 5 cases of complications related to laser use. One death was presumed to be due to intratumor explosion (the popcorn effect) after excessive Nd:YAG laser application. The other death was due to heat necrosis of the brain stem after radiation of an ependymoma of the 4th ventricle. Two patients suffered neurological deficits. One had facial palsy after radiation of the site of attachment of a meningioma to the petrous bone. The other suffered aphasia and hemiparesis due to heat damage to the cerebral cortex after laser coagulation of the overlying dura mater. The fifth patient suffered postoperative hemorrhage in a residual necrotic chromophobe adenoma after a transsphenoidal approach using the Nd:YAG laser. These complications are preventable. Suggestions are made for the safe use of this laser.