The Nd:YAG laser in neurosurgery. Part 2. Clinical studies: an adjunctive measure for hemostasis in resection of arteriovenous malformations

The Nd:YAG laser has been used safely to aid in the resection of 10 cases of parenchymal arteriovenous malformations (AVM's). The laser was found helpful for: 1) defining the plane between the AVM and the brain; 2) coagulating any dural component of the AVM; and 3) achieving hemostasis of the bed following resection of the lesions. However, its overall benefit in the resection of AVM's remains to be determined, as it could not arrest active high-flow bleeding from the thin-walled vessels feeding the deep portion of the AVM. This was attributed to the inherent characteristics of these vessels, since the instrument has been effective in non-AVM arteries of similar dimensions containing contractile elements in the vessel walls. Future refinements in focusing instrumentation and operative technique should enhance its capabilities and usefulness. When used within the recommended power range, the Nd:YAG laser is safe and its penetration predictable. The fiberoptic cable light delivery system allows excellent mobility of the handpiece, but the protective eyewear laser-light filters reduce the available light to the surgeon. The instrument appears promising but more work is required.