The Treatment of Arteriovenous Malformations of the Brain with the Neodymium: YAG Laser
The introduction of the Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser is the most recent technological adjunct advocated for the treatment of arteriovenous malformations (AVMs). Beck reported that Nd: YAG laser is effective for coagulation of brain tissue [1, 2]. Subsequent preliminary reports concerning the clinical effectiveness of the Nd: YAG laser for coagulation and induction of hemostasis associated with vascular tumors [9, 29], aneurysms , and AVMs [7, 8, 31, 34] have varied from enthusiastic to disappointing in content. Blood selectively absorbs the energy emitted by this laser wavelength and thrombosis of vessels can be effectively induced without imparting substantive damage to adjacent brain tissue . Because the operative removal of AVMs of the brain and particularly those arising from the central core remain one of neurosurgery’s major unresolved technical challenges, we have directed our efforts toward technical developments of the Nd: YAG laser as a mode of therapy. We agree with Wharen and colleagues that refinements are necessary . However, our experience in a substantial number of cases of complex AVMs confirms the safety of the device and indicates that it can be of inestimable benefit in the surgical extirpation of some malformations.
KeywordsArteriovenous Malformation Posterior Cerebral Artery Carbon Dioxide Laser Homonymous Hemianopsia Surgical Extirpation
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