Beneficial use of a new hand-held CO2 laser fiber in resection of a calcified and vascular intraventricular tumor.

Background The progression of laser technology in neurosurgery has been limited by the poor maneuverability of traditional line-of-sight carbon dioxide (CO 2 ) lasers and the propensity of other laser energies to cause collateral thermal injury to adjacent neural structures. The advent of a dielectric omnidirectional reflector and the subsequent development of phototonic bandgap fibers (PBF) have transformed the CO 2 laser into a low-profile instrument with considerable dexterity and many potential new neurosurgical applications. Case Description A 48-year-old woman presented with a large mass in the left lateral ventricle that was first diagnosed >20 years ago. The patient was asymptomatic until 1 month before presentation, when she began to experience progressive memory loss and neurocognitive decline. Results The hand-held CO 2 laser was used to debulk the tumor. The CO 2 laser vaporized neoplastic cellular material and simultaneously cauterized microvascular structures. Conclusions The CO 2 laser was exceptionally useful in the resection of this long-standing and extremely calcified, yet vascular mass. A review of the evolution of laser technology applications in neurosurgery is presented, with a specific focus on the innovations that led to the development of the new PBF CO 2 laser. This new technology may be advantageous in tumor surgery, particularly in the resection of long-standing calcified and vascular tumors that are not amendable to traditional surgical techniques.