The use of the Nd-YAG and the CO2 laser in neurosurgery.

Over the last 3 years 130 patients have been operated on using laser techniques. This technique was chosen where technical difficulties were anticipated due to the size, the vascular supply or the localization of the process. Although the use of laser techniques requires experimental work, before it can be applied clinically some distinct advantages could be demonstrated when compared with the use of the bipolar cautery. Due to its shrinking effect the laser beam is target oriented and makes the surgical procedure safe without the use of additional instruments. The Nd-YAG laser was preferred in tumors with a rich vascular supply. Thus there was a definitely decreased need for blood transfusions in patients operated on with the laser. Even those parts of the tumors that can not easily be reached, using conventional techniques can now be eliminated by laser irradiation. The variable distance between the handpiece of the laser instrument and the target organ allows a pin point as well as a more diffuse irradiation. Since it is not necessary to touch the tissue, laser techniques are particularly useful in critical areas, e.g. close to the brainstem or the spinal cord, because they make it unnecessary to touch the tissue. The question as to whether the use of laser technique will reduce the rate of recurrent tumor growth needs further studies based on longer follow-up periods. Further technical improvements are needed to make the laser device a true microinstrument. Finally a combination of both laser types--that is the Nd-YAG laser for coagulation and the CO2 laser for cutting--might be a definite advantage.