[Combined CO2 and Nd-YAG laser in neurosurgical practice. A 1st experience apropos of 40 intracranial procedures].

The authors present their experience concerning the use of Combolaser (Lasermatic, Finland), in neurosurgery. This laser-unit combines two wavelengths (CO2 and 1.06 Nd-YAG) which are emitted simultaneously and coaxially. During the last 12 months, 40 patients harbouring an intracranial tumor were operated upon with such a combolaser unit: 8 infra-tentorial, 32 supra-tentorial, 17 were meningiomas. The mean output power used during the procedures was 3-5 w for both CO2 and Nd-YAG beams. The authors discuss the advantages and inconveniences of such a laser; and they compare it with the other laser-units they have been using for the last 10 years: CO2-Laser, 1.06 Nd-YAG and 1.32 Nd-YAG laser. The main inconvenience of this unit is linked to the utilization of the articulated arm which conducts the CO2 laser beam. This drawback should be avoided or limited by the use of a fiber microguide, which will conduct both CO2 and Nd-YAG beams simultaneously. The principal contribution of a combined-laser unit is the quality of the haemostasis associated to a very good vaporization and cutting effect. When both wavelengths are synchronized, the combined laser beams penetrate into the nervous parenchyma more deeply than the only CO2 laser beam would with the same parameters. The vaporization effect is identical to that obtained with the isolated CO2 laser; the quality of haemostasis is limited to the effects of the Nd-YAG laser. Another advantage must be emphasized: the possibility of utilizing separately the CO2 laser and the 1.06 Nd-YAG.