Intracranial haemostasis with a neurosurgical CO2-laser unit

The authors have been using CO2-laser radiation routinely for more than 2 years. After having recalled the basic thermal properties of this beam, they present their experience. The goal of this work is to point out the particular benefit of CO2-laser cautery to perform tumoral haemostasis. The technical data of this CO2-laser haemostasis are detailed for 3 main indications: In cases of a precise origin of the haemorrhage, the coagulation of small intratumoural vessel necessitates a low output power: 2-4 watts in continued emission; 10-15 watts in the pulsed mode. The beam must be defocussed so as to be as large as the aimed vessel. A micro-manipulatotor is necessary for deeply located tumours. Basal meningiomas, neurinomas, giant adenomas are the best indications. If a diffuse bleeding is encountered in the operative cavity the output must be a little higher: 3-8 watts in continuous mode or 15-30 watts in the pulsed mode; first the cavity is swept with a defocussed CO2-laser ray; then the few larger vessels which have not been cauterized are coagulated one by one either by laser or by bipolar coagulation. The insertion zone of a meningioma can be efficiently coagulated by CO2-laser: a 150-200 watts output in the pulsed mode is necessary if the attachment is dural, a 300-400 watts pulsed output in the case of bony infiltration.