Two-Micron Continuous-Wave Laser-Assisted Neuroendoscopy: Clinical Experience of Two Institutions in 524 Procedures

• Published in: World neurosurgery 2019-02, Vol.122, p.e81-e88
• Main Authors: Schuhmann, Martin U., Kural, Cahit, Lalla, Lisanne, Ebner, Florian H., Bock, Christoph, Ludwig, Hans-Christoph
• Format: Article
• Language: English
• Subjects: Cyst fenestration; Endoscopic third ventriculostomy; Laser; Neuroendoscopy; Septostomy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.09.064

To present the clinical experience of 2 neurosurgical centers with the use of a 2-micron continuous-wave laser (2μ-cwL) system as standard tool in neuroendoscopic procedures and to discuss the safety and efficacy of this system. In total, 469 patients underwent neuroendoscopic procedures using 2μ-cwL between September 2009 and January 2015. All patient data were retrospectively reviewed. In total, 241 (51%) patients were children and 228 (49%) adults. Mean age was 27.5 years (range: 3 days to 83 years). Intraoperative ultrasonography or neuronavigation were used to guide ventricular or cyst puncture and for intraventricular or intracystic orientation if necessary. A total of 524 neuroendoscopic procedures using 2μ-cwL were performed. Laser-assisted endoscopic third ventriculostomy was the most common procedure in 302 (64%) patients. Cyst fenestration was performed in 124 (26%), septostomy in 45, tumor biopsy in 41, tumor resection in 8, and choroid plexus coagulation in 3 patients. There was no intraoperative complication directly attributable to the use of laser and an overall procedural complication rate of 4.8%. This large series of 2μ-cwL as a routine tool in neuroendoscopic procedures demonstrates that 2μ-cwL is safe for endoscopic third ventriculostomy, septostomy, cyst fenestration, and intraventricular tumor biopsy or resection. As a cutting and coagulation tool, it combines the action of mechanical tools like forceps, balloons, and scissors plus those of electric tools. It therefore renders neuroendoscopic procedures more straightforward with a minimum need to change tools. •2μ-cwL in the hands of experienced neuroendoscopic surgeons is rather less dangerous than the usual mechanical tools.•2μ-cwL has advantages over mechanical tools, i.e., the ability to cut and coagulate, and to create large holes in cyst walls.•Gaining experience and confidence in the use of 2μ-cwL is rather fast.•2μ-cwL is the abbreviation for 2-micron, continuous-wave laser.