CO2 laser surgery of intramedullary spinal cord tumors

Of a total of 580 patients suffering from expanding spinal disease, 15 cases of intramedullary lesions were dealt with by the use of the CO2 laser. Sharp cutting and precisely controlled depth effect are the advantages that make the CO2 laser very useful for surgery within the spinal cord. In tumors of tough consistency the neoplastic tissue is usually sharply demarcated, in which case the CO2 laser is used for dissection along this borderline, at an output energy of 15-20 W, infocus, continuous wave (CW). In tumors of soft consistency, characterized by a more-or-less diffuse zone of invasion--eg, glioblastomas-vaporization [20 W, out-of-focus, CW] and removal by ultrasound-microsuction is recommended. This procedure should advance layer by layer until normal looking tissue is reached. In this way intramedullary tumors may be removed with minimal side effects. The postoperative course involves less pain and less edematous reaction, and the rehabilitation time is shortened compared with conventional surgical treatment. In benign neoplasms long-term results are good; malignant cases require additional x-ray treatment and chemotherapy.