• Hani R Malone, Omar N Syed, Anthony L D'Ambrosio, and Guy M McKhann.
• Department of Neurosurgery, Columbia University Medical Center, Columbia University, College of Physicians & Surgeons, New York City, New York, USA. hrm2104@columbia.edu
• World Neurosurg. 2012 Jul 1;78(1-2):191.E9-14.

BackgroundThe progression of laser technology in neurosurgery has been limited by the poor maneuverability of traditional line-of-sight carbon dioxide (CO2) lasers and the propensity of other laser energies to cause collateral thermal injury to adjacent neural structures. The advent of a dielectric omnidirectional reflector and the subsequent development of phototonic bandgap fibers (PBF) have transformed the CO2 laser into a low-profile instrument with considerable dexterity and many potential new neurosurgical applications.Case DescriptionA 48-year-old woman presented with a large mass in the left lateral ventricle that was first diagnosed>20 years ago. The patient was asymptomatic until 1 month before presentation, when she began to experience progressive memory loss and neurocognitive decline.ResultsThe hand-held CO2 laser was used to debulk the tumor. The CO2 laser vaporized neoplastic cellular material and simultaneously cauterized microvascular structures.ConclusionsThe CO2 laser was exceptionally useful in the resection of this long-standing and extremely calcified, yet vascular mass. A review of the evolution of laser technology applications in neurosurgery is presented, with a specific focus on the innovations that led to the development of the new PBF CO2 laser. This new technology may be advantageous in tumor surgery, particularly in the resection of long-standing calcified and vascular tumors that are not amendable to traditional surgical techniques.Copyright © 2012 Elsevier Inc. All rights reserved.

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