A new fiber-mediated carbon dioxide laser facilitates pediatric spinal cord detethering

Technical note

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Object

The authors report their experience with a novel flexible fiber capable of transmitting CO2 laser energy during spinal cord tumor resection and detethering.

Methods

A fiber optic system capable of transmitting CO2 laser energy was used in the detethering of the spinal cord in 3 cases. The first case involved a 9-year-old girl with a terminal lipoma. The second case was an 11-month-old boy with a thoracic intramedullary dermoid and dermal sinus tract. The third case involved a 13-year-old girl suffering from a tethered spinal cord subsequent to a previously repaired myelomeningocele.

Results

In all 3 cases, the new fiber CO2 laser technology allowed the surgeon to perform microsurgical dissection while sparing adjacent neurovascular structures without time-consuming setup. The system was easy to implement, more ergonomic than previous technologies, and safe. The CO2 laser provided the ability to cut and coagulate while sparing adjacent tissue because of minimal energy dispersion and ease of use, without the articulating arms involved in the prior generation of lasers.

Conclusions

Using a flexible fiber to conduct CO2 laser energy allows accurate microneurosurgical dissection and renders this instrument a high-precision and ergonomic surgical tool in the setting of spinal cord detethering.

Article Information

Address correspondence to: Richard G. Ellenbogen, M.D., Division of Pediatric Neurological Surgery, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, Washington 98105. email: rge@u.washington.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Photograph of the laser system used in this study. The laser system comprises a CO2 source, adaptor (housing the optical array that passes the laser energy into the fiber), sterile gas path filter, flexible waveguide hollow core CO2 BP-Neuro fiber, and handpiece. The surgeon wields the fiber in the handpiece as a pencil, bringing it to within millimeters of the target tissue. The distal tip of the dissector handpiece may be applied directly to the tissue, allowing for precise control while protecting the fiber tip from adhering to tissue during the procedure. Photograph used with permission of OmniGuide, Inc.

  • View in gallery

    Case 1. Preoperative (A) and intraoperative (B–D) images of the patient. The MR image (A) indicates the pathological region (red circle). The surgeon holds the handpiece (B, star) and applies CO2 energy to the lipoma to debulk the mass. Dissection along the margin was enabled by moving the handpiece and fiber closer to the tissue (C). At the conclusion of the procedure, the spinal cord was released and retracted approximately 2 cm (D).

  • View in gallery

    Case 2. Preoperative (A) and intraoperative (B–E) images of the patient. The MR image (A) shows the tract and intramedullary lesion (red circle). The CO2 laser (B–D, star) was used to dissect around the tract down to the dura and then remove the lesion from its location within the spinal cord (B) by opening the pia-arachnoid plane (C and D). Note the golden fiber tip protruding from the silver-colored handpiece (C and D). Subsequently, the intramedullary dermoid (E, black arrow) was removed from within the spinal cord.

References

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