Efficacy and versatility of the 2-micron continuous wave laser in neuroendoscopic procedures

Laser-assisted techniques offer a huge potential in neurosurgery, but have achieved little acceptance to date. One reason is the concern regarding heat production, uncontrollable and distant penetration, and tissue interaction.We describe our experience with a 2-micron continuous wave laser (RevoLix jr.; LISA Laser Products OHG, Katlenburg-Lindau, Germany) for neuroendoscopic intraventricular procedures.The laser beam is delivered through flexible fibers. In an aqueous medium, the effect is restricted to <2 mm in front of the tip with tissue penetration depth of 500 μm.Forty-four patients (25 adults, 19 children) were operated on using the endoscopic, laser-assisted technique for treatment of obstructive hydrocephalus (n = 39), pure cyst fenestration (n = 4), or pure tumor biopsy (n = 1). All 53 procedures were successfully performed in those 44 operations, with the laser being the main effective instrument used (except for biopsy). Besides one clinically silent small intracisternal hemorrhage and one worsening of a preexisting oculomotor palsy (following fenestration of multiple midbrain cysts), no procedure-related complications occurred.The 2-micron continuous wave laser is a most valuable and useful tool, in our experience with safe applicability for endoscopic intracranial procedures in patients of all ages.