The Utility of Thulium Laser in Neuroendoscopy

Neuroendoscopy is presently considered a minimally invasive surgical approach. Comparatively, a microsurgical approach to ventricles allows using quickly several instruments and material for hemostasis, cutting and excision. Despite wonderful magnification recently improved, the bleeding control and tumor ablation are harmful by standard tools through the narrow channel of the neuroendoscope. Specially, in vascularized tumors and near vital structures the traditional electrosurgery can be ineffective and dangerous. In ventricular neuroendoscopy the ideal tool is one thin instrument for easy coagulation, cutting and ablation by saving healthy tissue. Laser is the instrument that can realize these effects through one working channel without changing several devices and time consuming. Since the 1960s many types of lasers have been used in neurosurgery [1]. In literature, the most popular lasers used in neurosurgery consist of different medium (CO2 or Nd: YAG) with different properties, based on: wavelength (micron, μ), power output (watts), beam density (spot size) and time of exposure. The CO2 laser is an excellent cutting tool, but has a limited hemostasis control. The Nd: YAG laser is very useful for coagulation, but has wide thermal effects. Both lasers work only in air and not in aqueous field as in the cerebral spinal fluid (CSF) of ventricles. Since 2007, the thulium (Tu) laser (Revolix Jr., LISA laser products) has been introduced in neuroendoscopy for third ventriculostomy (ETV) The Utility of Thulium Laser in Neuroendoscopy