Technology High-Power Diode Laser in Neurosurgery: Clinical Experience in 30 Cases Bertrand C. Devaux, M.D., Franc ¸ois-Xavier Roux, M.D., Franc ¸ois Nataf, M.D., Barish Turak, M.D., and Corneliu Cioloca, M.D. Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France Devaux BC, Roux F-X, Nataf F, Turak B, Cioloca C. High-power diode laser in neurosurgery: Clinical experience in 30 cases. Surg Neurol 1998;50:33– 40. BACKGROUND High-power semiconductor diode lasers were recently introduced and have been tested in ophthalmology and general surgery. These lasers are attractive from the practical and economical standpoint, and have enough power to perform most surgical procedures. They could replace other surgical lasers such as CO 2 , argon, 1.06 m, and 1.32 m Nd-YAG lasers for many applications in neu- rosurgery. We report our initial experience with the first available 0.805-m surgical diode laser, the Diomed 25 (Diomed, Ltd, Cambridge, U.K.) in a series of 30 patients. METHODS The diode laser was evaluated during surgical resection of various types of central nervous system tumors in 30 patients. It was used free-hand in 27 patients in contact and non-contact, continuous wave (cw) and pulsed modes, and during ventricular endoscopy in three pa- tients. Average time of laser use during a procedure was 248 seconds. Output power ranged from 1 to 25 watts, with an average power per patient of 2.64 to 15.5 watts (mean, 8.78 watts). Total energy delivered ranged from 65 to 11,051 joules per patient. RESULTS Using 600- or 400-m non-contact optic fiber, well pig- mented tumor tissue hemostasis was obtained at cw 3 to 10 watts with a defocused beam, whereas vaporization required 10-25 cw or pulsed watts with a focused beam. Soft and tough tissue section could be obtained using a sculpted cone-shaped (600-300 m tip) contact fiber at 7-10 cw watts after fiber tip charring. Because of the deeper penetration of 0.805-m light in non-pigmented tissues, non-contact mode is not recommended for white matter or poorly vascularized tumors. The contact mode was not efficient on very soft tissues such as edematous brain parenchyma. The contact fibers proved to be very fragile because of heat generation. CONCLUSIONS The high power diode laser proved to be efficient for hemostasis, section and vaporization, using contact and non-contact modes, at different output powers. Econom- ical and ergonomical advantages of this new generation of surgical lasers may cause them to replace other surgi- cal lasers such as argon, CO 2 , and Nd-YAG lasers, mostly for tumor surgery. © 1998 by Elsevier Science Inc. KEY WORDS Diode laser, surgical lasers, tumor removal, neuroendoscopy. T he application of lasers in neurosurgery both experimentally and clinically started in the late 1970s with the use of CO 2 [2,18], followed by 1.06-m Nd-YAG [3,40], argon [4,27], and more re- cently by the 1.32-m Nd-YAG [24,30,31], and 1.44 m Nd-YAG [21] lasers. Today, these laser sources are widely used by neurosurgeons, mostly for the removal of intracranial and spinal cord tumors, as well as vascular malformations, and have well documented properties and indications during neu- rosurgical procedures [12,14,32,33]. The major dis- advantages of these lasers are their poor maneu- verability because of their bulk and necessary setup such as power supply, water and gas equip- ment; cumbersome articulated arms for the CO 2 laser; and high purchase and maintenance cost. Therefore, the recently developed high-power di- ode lasers seem to be attractive from practical and economical standpoints [20]. Recent experiments on different tissues—from animals and surgically removed human tissues— demonstrated the potential benefits of diode lasers in surgery [19,28,29,41,42]. After experiments on the brains of rabbits [8], we started to use the first commercially available high power diode laser in neurosurgical practice [7,9]. We report here our initial experience in a series of 30 neurosurgical procedures. Address reprint requests to: Dr. Bertrand C. Devaux, Service de Neuro- chirurgie, Centre Hospitalier Sainte-Anne. 1, Rue Cabanis, 75674 Paris Cedex, France. Received March 12, 1996; accepted November 21, 1997. © 1998 by Elsevier Science Inc. 0090-3019/98/$19.00 655 Avenue of the Americas, New York, NY 10010 PII S0090-3019(98)00042-1