By R. E. Anderson, J. E. Boggan, L. J. Cerullo, M. C. Chan, G. J. Dohrmann, M. S. B. Edwards, V. A. Fasano, J. M. Gilsbach, A. Harders, R. M. Ikeda, P. J. Kelly, E. R. Laws Jr., G. Lee, T. Letardi, D. T. Mason, C. R. Neblett, R. W. Rand, A. Renieri, I. L. Ri

Since the advent of electrosurgery the concepts of surgical procedure at the fearful procedure have gone through additional advancements (bipolar coagulation, microscope), whether the strategy was once no longer considerably converted. this day, laser represents a brand new "discipline", because it bargains a brand new means of appearing all simple maneuvers (dissection, demolition, hemostasis, vessel sutures). additionally, laser bargains the potential of a distinct maneuver, specifically aid of the amount of a tumoral mass via vaporization. Its program isn't constrained to conventional neurosurgery yet extends additionally to stereotactic and vascular neurosurgery. Laser surgical procedure has additionally inspired the anesthesiologic options. whilst new instrumentation has been brought: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. i've got had the opportunity to make use of those new applied sciences all at a time and feature come to the belief that we face the sunrise of a brand new technique which has already proven its validity and absence of inconveniences, and whose item is to extend the precision of neurological surgical procedure. The technological improvement remains to be happening, and a few advancements are to be foreseen. Laser scalpel is splitting the preliminary laser surgical procedure into NO­ contact and contact surgical procedure with laser. As new instrumentarium might be constructed, a variable and tunable beam turns into on hand. for instance, in many years unfastened Electron Laser will extra upload to the growth during this field.

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6 mm probes were developed, which make it easily 32 J. M. Gilsbach and A. Harders: possible to record the individual parts of the circle of Willis (Fig. 3). The probes could be sterilized with gas for direct intraoperative investigations. 2 mm. The •• Fig. 2. The present appearance of the microvascular Doppler system with a built in spectrum analyzer (EME, Uberlingen, Germany) Table 1. 1 kHz transcutaneous application was restricted to superficial vessels because of the low penetration depth (in clinical practice not more than 5 mm).

Ponzio, R. , 1982: Observations on the simultaneous use of CO 2 and Nd: Y AG laser in neurosurgery. Lasers Surg. Med. 155. 6. Jako, G. , 1972: Laser surgery of the vocal cords. An experimental study with carbon dioxide laser. Laryngoscope 8, 2204. 7. , Bennet, W. , Herriot, D. , 1961: Population inversion and continuous optical Maser oscillation in gas discharge containing a He-Ne misture. Phys. Rev. 6, 106. 8. , 1972: Argon laser treatment of brain tumors sensitized by acridine orange. Med. J.

It has meanwhile undergone many modifications and is now commercially available (Eden 1984). The system is a pulsed Doppler with an emitted frequency of 20 MHz (Fig. 2, Table 1), a built in zero-crosser, an automatic gate shift, and adjustable pulse repetition frequencies and adjustable pulse durations (pulse duration = duration of the receiving period). We exclusively use a pulse repetition frequency of 100 kHz, which offers the highest possible resolution. 5 kHz by the filter arrangement. But in neurosurgical clinical practice, frequencies higher than 8-10 kHz have only been rarely found in cases of angiomas and severe vasospasms.

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