A new fiber-mediated carbon dioxide laser facilitates pediatric spinal cord detethering

Abstract

Object The authors report their experience with a novel flexible fiber capable of transmitting CO2 laser energy during spinal cord tumor resection and detethering. Methods A fiber optic system capable of transmitting CO2 laser energy was used in the detethering of the spinal cord in 3 cases. The first case involved a 9-year-old girl with a terminal lipoma. The second case was an 11-month-old boy with a thoracic intramedullary dermoid and dermal sinus tract. The third case involved a 13-year-old girl suffering from a tethered spinal cord subsequent to a previously repaired myelomeningocele. Results In all 3 cases, the new fiber CO2 laser technology allowed the surgeon to perform microsurgical dissection while sparing adjacent neurovascular structures without time-consuming setup. The system was easy to implement, more ergonomic than previous technologies, and safe. The CO2 laser provided the ability to cut and coagulate while sparing adjacent tissue because of minimal energy dispersion and ease of use, without the articulating arms involved in the prior generation of lasers. Conclusions Using a flexible fiber to conduct CO2 laser energy allows accurate microneurosurgical dissection and renders this instrument a high-precision and ergonomic surgical tool in the setting of spinal cord detethering.