Laser-assisted neuroendoscopy using Nd:YAG and diode contact laser with black fiber tips

Although lasers have proven to be valuable in neuroendoscopy, surgeons still do not feel comfortable using high-energy laser endoprobes in close proximity to vital structures. A special laser catheter was developed with an atraumatic ball-tip which was pretreated with a layer of carbon particles absorbing 90% of the energy. The temperature at the surface of this 'black' tip reaches ablative temperatures instantly at powers of only a few watts within one second. This drastically limits the laser power and the length of exposure needed, increasing safety, even around critical structures. The characteristics of the 'black' tips were studied using a thermal imaging technique, showing heat just in front of the tip in contrast to uncoated fiber tips. These 'black' tips were applied in combination with Nd:YAG and diode lasers in 41 patients and a variety of procedures: third ventriculocisternostomy (n equals 27), cyst fenestration (n equals 8), colliod cyst resection (n equals 5) and fenestration of the septum pellucidum (n equals 1). Power ranged from 0.5 to 5 W and the average total energy for ventricular fenestration was 160 J. There was no mortality, nor increased morbidity. The procedure success rate was 100% and the overall outcome success rate was 90%. 'Black' atraumatic ball-shaped fiber tips are safe and effective in a variety of neuro-endoscopic procedures. Due to the low power range of only several watts, compact diode lasers are the energy source of first choice.