• Martin U Schuhmann, Cahit Kural, Lisanne Lalla, Florian H Ebner, Christoph Bock, and Hans-Christoph Ludwig.
• Division of Pediatric Neurosurgery, Department of Neurosurgery, Eberhard Karls University Hospital of Tübingen, Tübingen, Germany.
• World Neurosurg. 2019 Feb 1; 122: e81-e88.

ObjectiveTo 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.MethodsIn 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.ResultsA 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%.ConclusionsThis 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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