Laser Applications In Neurosurgery

Developments in the field of instrumentation of innovative instrumentation. Although laser applications have permeated nearly every aspect are among the major contributions to human advancement. The history of surgery has seen of surgical therapy, the expectations have fre many revolutionary developments cause quantum quently been unrealistic and the evaluation of leaps in progress. Electrocautery, the anesthesia technological development has always been machine, computed axial tomography, and the painfully slow. The properties of vaporization, surgical microscope are all revolutionary in coagulation, and cutting unified in an invisible struments that have irrevocably changed the shaft of light have enabled the neurosurgeon to direction of neurological surgery. vaporize inaccessible tumors of brain and spinal In the early stages of application, there are cord, harness recalcitrant bleeding sites, and cut always detractors and valid controversy concern through the most formidable calcified tumors. ing the value of a new instrument. Some will The application of this new energy form in remember those who argued that the magnifica tandem with the surgical microscope has, in my tion and illumination provided by the micro opinion, extended the scope of all aspects of scope were not valuable to the skilled surgeon neurosurgery. We have much more work to do. and would prolong the operative time and in lt is necessary to document improved results and crease infection rates. Others may recall that demand technological advances and safe inno Cushing was told to abandon the blood pressure vations.

This book is the result of the authors' many years of experience in using neurosurgical lasers. They began using laser diodes in their speciality at the start of the 1990s, making them pioneers in the field. The first part of the book deals with the general physical bases and comparative bio-tissue effects of the various kinds of surgical laser, safety measures required and legislation concerning powerful lasers. The second part focuses on laser diodes alone. The authors describe in detail how they use them to operate on intracranial and intraspinal tumours, in intraventricular endoscopy, and in surgery involving epilepsy. Details are given of: technical data; the choice of parameters depending on how the lasers are used (contact and non-contact, and the type of lesion being operated on) as well as their indications in neurosurgery. The authors emphasise the practical recommendations that make this book a valuable companion for current and potential users working in neurosurgery and other surgical applications. They also mention the new and future uses of laser diodes which are currently being developed and which show that this equipment really does represent a new generation of lasers. About 100 colour illustrations and tables are used to explain and underscore the authors' points.

This book is a review of past and current studies and future plans of the Laser Laboratory in Cincinnati and some of the contributions of laser research groups in other medical centers. Special thanks are due to the Directing Physicist of the Laser Labora tory, R. James Rockwell. Without his advice, constant supervision and corrections, this enthusiastic investigator would continue to upset even many more people than he has done already. The excuse, of course, is to stimulate much needed interest and controlled research and development of the laser for biology and medicine. The Associate Research Physicist, Ralph Schooley, has worked with many phases of laser research but especially in Q spoiling, Raman spectroscopy, and the almost alchemy of holography. Holography, as of now, provides many opportunities for Gumperson's Law, "If anything can go wrong, it will. " Sincere appreciation is expressed to the Surgeons in the Laser Labora tory, who have supplied clinical and investigative surgical supervision often under great difficulties, Dr. V. E. Siler and Dr. Bruce Henderson. We are grateful for help from the Directing Biologist of the Laser Labo ratory, Edmond Ritter, the Director of Laser Neurosurgery, Dr. Thomas Brown and the Professor of Neurosurgery, Dr. Robert McLaurin, for important and basic work in laser neurosurgery. Special thanks are given to Robert Meyer, who has given most of the treatments in careful and skillful fashion, and his associate, Robert Otten.

Since the introduction of electrosurgery the techniques of surgery on the nervous system have passed through further improvements (bipolar coagulation, microscope), even if the procedure was not substantially modified. Today, laser represents a new "discipline", as it offers a new way of performing all basic maneuvers (dissection, demolition, hemostasis, vessel sutures). Furthermore, laser offers the possibility of a special maneuver, namely reduction of the volume of a tumoral mass through vaporization. Its application is not restricted to traditional neurosurgery but extends also to stereotactic and vascular neurosurgery. Laser surgery has also influenced the anesthesiologic techniques. At the same time new instrumentation has been introduced: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. I have had the chance to utilize these new technologies all at a time and have come to the conclusion that we are facing the dawn of a new methodology which has already shown its validity and lack of inconveniences, and whose object is to increase the precision of neurological surgery. The technological development is still going on, and some improvements are to be foreseen. Laser scalpel is splitting the initial laser surgery into NO TOUCH and TOUCH surgery with laser. As new instrumentarium will be developed, a variable and tunable beam will become available. For example, in a few years Free Electron Laser will further add to the progress in this field.

The advent in the 1960s of the unique and exciting new form of energy called laser brought to medicine a marvelous tool that could accomplish new treatments of previously untreatable disorders as well as improved treat ment of mundane problems. This brilliant form of light energy is many times more powerful than the energy of the sun yet can be focused microscopically to spot sizes as small as 30 microns. Lasers can be directed into seemingly inaccessible areas by mirrors or fiberoptic cables or can be directly applied into sensitive areas such as the retina without damage to intervening structures. There has been a rapid proliferation in the use of lasers in all surgical specialties. Starting with bold ideas and experiments of "thought leaders" in each specialty, the application of lasers has evolved into commonplace usage. Beginning with the era when laser presentations and publications were an oddity, now nearly all specialty areas have whole sections of meetings or journals devoted exclusively to laser usage. Laser specialty societies within a specialty have developed and residency training programs routinely instruct trainees in laser techniques. Basic science and clinical experimentation has supported laser knowledge. Laser usage has also become international. Newer wavelengths and accessories have added to the armamentarium of laser usage. Despite the rapid growth in laser interest, no single source exists to instruct the many new laser users in proper, safe, and effective use of this new modality.