Er:YAG laser brain surgery with vascular specific coagulation.
Er:YAG
Yb fiber-laser
brain
laser surgery
neurosurgery
Journal
Lasers in surgery and medicine
ISSN: 1096-9101
Titre abrégé: Lasers Surg Med
Pays: United States
ID NLM: 8007168
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
revised:
14
07
2022
received:
20
02
2022
accepted:
21
07
2022
pubmed:
11
8
2022
medline:
14
9
2022
entrez:
10
8
2022
Statut:
ppublish
Résumé
Erbium:yttrium-aluminum-garnet (Er:YAG) laser ablation can effectively resect water-bearing tissues. Application of Er:YAG resection in neurosurgery is complicated by unpredictable bleeding in surgical field. Recently, an integrated theranostic system combining a dual-wavelength laser surgery system using a thulium (Tm) fiber-laser for coagulation and Er:YAG for resection, combined with optical coherence tomography (OCT) guidance was demonstrated for the in vivo resection of tumor tissue. However, lateral thermal spread in the range of 100s of micrometers is common due to lack of vascular specificity using a Tm fiber-laser for coagulation. In this study, a vascular specific ytterbium (Yb) fiber-laser is utilized for enhanced photocoagulation during in vivo neurosurgery improving the precision of Er:YAG tissue resection with minimal lateral thermal spread. Mice underwent stereotactic laser surgery with the proposed Yb/Er:YAG dual wavelength vascular specific neurosurgery in vivo. An OCT system (wavelength range 1310 ± 70 nm) and OCT derived angiography images were used to record cortical images to confirm the coagulation of blood vessels and guide subsequent Er:YAG resection steps. After the laser surgery, mice were killed, and histological analysis was carried out using hematoxylin and eosin staining and Nissl staining to compare the lateral thermal spread with our previously reported Tm/Er:YAG neurosurgery where a continuous wave Tm fiber-laser was used for coagulation. Coagulation scheme using a Yb fiber-laser allowed stoppage of blood flow in disparately sized blood vessels encountered in the mice brain. Histological analysis of murine brain slices post Yb/Er:YAG laser surgery yielded lower thermal spread compared with Tm/Er:YAG laser surgery, maximizing the efficiency in both hemostasis (blood flow stoppage) and maximizing tissue ablation efficiency with minimal residual thermal damage zone. In this study, a vascular specific coagulation scheme with Yb/Er:YAG dual-wavelength surgery is presented for neurosurgery. Additionally, Yb/Er:YAG study results are compared with that of a tissue coagulation approach in Tm/Er:YAG surgery previously reported to highlight improved coagulation, reduced nonspecific thermal damage and limited lateral thermal spread. Experimental results suggest that the developed dual-wavelength laser system can effectively resect neural tissues with high localization, minimal lateral thermal spread at the micrometer level while maintaining a bloodless surgical field.
Sections du résumé
BACKGROUND AND OBJECTIVE
Erbium:yttrium-aluminum-garnet (Er:YAG) laser ablation can effectively resect water-bearing tissues. Application of Er:YAG resection in neurosurgery is complicated by unpredictable bleeding in surgical field. Recently, an integrated theranostic system combining a dual-wavelength laser surgery system using a thulium (Tm) fiber-laser for coagulation and Er:YAG for resection, combined with optical coherence tomography (OCT) guidance was demonstrated for the in vivo resection of tumor tissue. However, lateral thermal spread in the range of 100s of micrometers is common due to lack of vascular specificity using a Tm fiber-laser for coagulation. In this study, a vascular specific ytterbium (Yb) fiber-laser is utilized for enhanced photocoagulation during in vivo neurosurgery improving the precision of Er:YAG tissue resection with minimal lateral thermal spread.
METHODS
Mice underwent stereotactic laser surgery with the proposed Yb/Er:YAG dual wavelength vascular specific neurosurgery in vivo. An OCT system (wavelength range 1310 ± 70 nm) and OCT derived angiography images were used to record cortical images to confirm the coagulation of blood vessels and guide subsequent Er:YAG resection steps. After the laser surgery, mice were killed, and histological analysis was carried out using hematoxylin and eosin staining and Nissl staining to compare the lateral thermal spread with our previously reported Tm/Er:YAG neurosurgery where a continuous wave Tm fiber-laser was used for coagulation.
RESULTS
Coagulation scheme using a Yb fiber-laser allowed stoppage of blood flow in disparately sized blood vessels encountered in the mice brain. Histological analysis of murine brain slices post Yb/Er:YAG laser surgery yielded lower thermal spread compared with Tm/Er:YAG laser surgery, maximizing the efficiency in both hemostasis (blood flow stoppage) and maximizing tissue ablation efficiency with minimal residual thermal damage zone.
CONCLUSION
In this study, a vascular specific coagulation scheme with Yb/Er:YAG dual-wavelength surgery is presented for neurosurgery. Additionally, Yb/Er:YAG study results are compared with that of a tissue coagulation approach in Tm/Er:YAG surgery previously reported to highlight improved coagulation, reduced nonspecific thermal damage and limited lateral thermal spread. Experimental results suggest that the developed dual-wavelength laser system can effectively resect neural tissues with high localization, minimal lateral thermal spread at the micrometer level while maintaining a bloodless surgical field.
Substances chimiques
Erbium
77B218D3YE
Thulium
8RKC5ATI4P
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1107-1115Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Barker FG, Chang SM. Improving resection of malignant glioma. Lancet Oncol. 2006;7(5):359-60. https://doi.org/10.1016/S1470-2045(06)70669-6
Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery. 2008;62(4):753-66. https://doi.org/10.1227/01.neu.0000318159.21731.cf
Zheng L, Wan J, Long Y, Fu H, Zheng J, Zhou Z. Effect of high-frequency electric field on the tissue sticking of minimally invasive electrosurgical devices. R Soc Open Sci. 2021;5(7):180125. https://doi.org/10.1098/rsos.180125
Harati A, Scheufler KM, Schultheiss R, Tonkal A, Harati K, Oni P, et al. Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression. Surg Neurol Int. 2017;8:45. https://doi.org/10.4103/sni.sni_129_16
Kim J, Moon IS, Jeong JH, Lee HR, Lee WS. What really decides the facial function of vestibular schwannoma surgery? Clin Exp Otorhinolaryngol. 2011;4(4):168-73. https://doi.org/10.3342/ceo.2011.4.4.168
Katta N, McElroy AB, Estrada AD, Milner TE. Optical coherence tomography image-guided smart laser knife for surgery. Lasers Surg Med. 2017;50:202-12. https://doi.org/10.1002/lsm.22705
Katta N, Estrada AD, McElroy AB, Gruslova A, Oglesby M, Cabe AG, et al. Laser brain cancer surgery in a xenograft model guided by optical coherence tomography. Theranostics. 2019;9(12):3555-64. https://doi.org/10.7150/thno.31811
Beaudette K, Strupler M, Benboujja F, Parent S, Aubin C, Boudoux C. Optical coherence tomography for the identification of musculoskeletal structures of the spine: a pilot study. Biomed Opt Express. 2012;3(3):533-42.
Babilas P, Shafirstein G, Bäumler W, Baier J, Landthaler M, Szeimies RM, et al. Selective photothermolysis of blood vessels following flashlamp-pumped pulsed dye laser irradiation: in vivo results and mathematical modelling are in agreement. J Invest Dermatol. 2005;125(2):343-52. https://doi.org/10.1111/j.0022-202X.2005.23773.x
El-Sherif AF, King TA. Soft and hard tissue ablation with short-pulse high peak power and continuous thulium-silica fibre lasers. Lasers Med Sci. 2003;18(3):139-47. https://doi.org/10.1007/s10103-003-0267-5
Gu M. Laser Er:YAG Ablation of cerebellar and cerebral tissue. Lasers Surg Med. 2001;16:40-3.
Omi T, Numano K. The role of the CO2 laser and fractional CO2 laser in dermatology. Laser Ther. 2014;23(1):49-60. https://doi.org/10.5978/islsm.14-RE-01
Majaron B, Kelly KM, Park HB, Verkruysse W, Nelson JS. Er: YAG laser skin resurfacing using repetitive long-pulse exposure and cryogen spray cooling: I. histological study. Lasers Surg Med. 2001;130:121-30.
Vitruk P, Levine R. Hemostasis and coagulation with ablative soft-tissue dental lasers and hot-tip devices. Inside Dentistry. 2016;8:1-4.
Kaufmann R, Hibst R. Pulsed erbium:YAG laser ablation in cutaneous surgery. Lasers Surg Med. 1996;19(3):324-30. https://doi.org/10.1002/(SICI)1096-9101(1996)19:3
Gülsoy M, Elikel TCQ, Kurt A, Canbeyli R, Ilesiz ICQ. Er:YAG laser ablation of cerebellar and cerebral tissue. Lasers Med Sci. 2001;16(1):40-3. https://doi.org/10.1007/pl00011335
Niemz MH. Laser-tissue interactions. vol. 322. Berlin, Heidelberg: Springer-Verlag; 2007.
Vogel A, Venugopalan V. Mechanisms of pulsed laser ablation of biological tissues. Chem Rev. 2003;103(2):577-644.
Rox Anderson R, Parrish JA. Microvasculature can be selectively damaged using dye lasers: a basic theory and experimental evidence in human skin. Lasers Surg Med. 1981;1(3):263-76. https://doi.org/10.1002/lsm.1900010310
Lanigan SW, Taibjee SM. Recent advances in laser treatment of port-wine stains. Br J Dermatol. 2004;151:527-33. https://doi.org/10.1111/j.1365-2133.2004.06163.x
Tunnell JW, Chang DW, Johnston C, Torres JH, Patrick Jr CW, Miller MJ, et al. Effects of cryogen spray cooling and high radiant exposures on selective vascular injury during laser irradiation of human skin. Arch Dermatol. 2003;139(6):743-50.
Barton JK, Rollins A, Yazdanfar S, Pfefer TJ, Westphal V, Izatt JA. Photothermal coagulation of blood vessels: a comparison of high-speed optical coherence tomography and numerical modelling. Phys Med Biol. 2001;46:1665-78.
Kimel S, Svaasand LO, Hammer-Wilson M, Schell MJ, Milner TE, Nelson JS, et al. Differential vascular response to laser photothermolysis. J Invest Dermatol. 1994;103(5):693-700. https://doi.org/10.1111/1523-1747.ep12398548
Rox RA, Jaenicke KF, Parrish JA. Mechanisms of selective vascular changes caused by dye lasers. Lasers Surg Med. 1983;3(3):211-15. https://doi.org/10.1002/lsm.1900030303
Garden JM, Polla LL, Tan OT. The treatment of port-wine stains by the pulsed dye laser: analysis of pulse duration and long-term therapy. Arch Dermatol. 1988;124(6):889-96. https://doi.org/10.1001/archderm.1988.01670060035012
Katta N, Santos D, McElroy AB, Estrada AD, Das G, Mohsin M, et al. Laser coagulation and hemostasis of large diameter blood vessels: effect of shear stress and flow velocity. Sci Rep. 2022;12(1):8375. https://doi.org/10.1038/s41598-022-12128-1
Katta N, Estrada AD, McElroy AB, Milner TE. Fiber-laser platform for precision brain surgery. Biomed Opt Express. 2022;13(4):1985. https://doi.org/10.1364/boe.449312
Kadar A, Wittmann Gabor, Liposits Zsolt. Improved method for combination of immunocytochemistry and Nissl staining. J Neurosci Methods. 2010;184(1):115-8. https://doi.org/10.1016/j.jneumeth.2009.07.010
Messner M, Heinrich A, Hagen C, Unterrainer K. High brightness diode pumped Er:YAG lasers. In: Solid state lasers: technology and devices; vol. 9726. Proc. SPIE, San Francisco, CA. 2016. https://doi.org/10.1117/12.2209098
McKenzie AL. Physics of thermal processes in laser-tissue interaction. Phys Med Biol. 2003;35(9):1175-209. https://doi.org/10.1088/0031-9155/35/9/001