The laser in neurological surgery

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✓ The use of lasers in neurosurgical procedures has received a great deal of attention recently. Surgical use of lasers has been viewed with suspicion and skepticism, probably because of (justified) apprehensions about the misuse of lasers in early work and about the ways in which laser light affects tissues, and a lack of understanding of the basic physics and practical operation of lasers. The authors review the physics, biophysics, experimental findings, and operative use of lasers in current neurosurgical practice, and discuss briefly their experience gained in over 150 neurosurgical procedures using the carbon dioxide and argon surgical lasers.

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Address reprint requests to: Michael S. B. Edwards, M.D., c/o The Editorial Office, Department of Neurological Surgery, 350 Parnassus Avenue, Suite 807, San Francisco, California 94117.

© AANS, except where prohibited by US copyright law.

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Figures

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    Simple diagram of the absorption phenomenon. A: Absorption of a photon. B: Spontaneous emission of a photon. C: Stimulated emission of a photon. Wavy line = energy (photon); circle = atom or molecule; straight line = arbitrary energy level.

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    Diagram of a simple laser. A: The optical resonator or laser cavity. B: Excitation of the laser medium. C: Amplification. STE = stimulated emission; SPE = spontaneous emission; ABS = absorption. Wavy line = energy (photon); open circle = ground state of atom or molecule; closed circle = excited state of atom or molecule.

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    Diagrammatic representation of nondestructive interactions of laser light with tissue. Left: For incision, a high-power focused beam with small-spot diameter is needed. Center: Vaporization requires a high-power focused beam with small- to large-spot diameter. Right: Coagulation requires a low-power defocused (divergent) beam with medium- to large-spot diameter.

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    Left: Diagram of the zone of tissue injury caused by focused laser light. Right: Histologic cross-section of damage to the frontal lobe of a rat caused by a CO2 laser beam at a power density of 15,000 W/sq cm applied for 0.5 seconds. H & E, × 50.

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    Diagram of the effects of laser light on neural tissue.

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