Fiberoptic Delivery of Laser Energy to Remove Occlusions from Ventricular Shunts: Technical Report

Fiberoptic Delivery of Laser Energy to Remove Occlusions from Ventricular Shunts: Technical Report AbstractOBJECTIVE:Shunts frequently require surgical replacement because occlusions block the ventricular tubing. We have examined the hypothesis that a surgical laser coupled to an optical fiber can deliver sufficient energy to disrupt the occlusion in situ and thus afford a less invasive method of repair.METHODS:Choroid plexus tissue found in shunts explanted from patients, model tissues such as polyacrylamide gel, and animal tissues inserted into shunts were examined. Occlusions were fragmented by pulsed laser energy of 2.09-/mm wavelength and 300-microsecond duration delivered via a flexible optical fiber several meters in length. The methods and conditions were similar to those likely to be used for preclinical in vivo studies.RESULTS:Short-lived vapor bubbles generated at the fiber tip disrupted occlusions within the shunt and expelled tissue blocking the inflow holes. Energy requirements to disrupt and remove occlusions in vitro were determined. Laser pulse energies and exposure thresholds that cause intentional damage to shunts also were determined.CONCLUSION:Laser energies needed to disrupt occlusions were below the energy needed to damage the shunt components. Our results show that a strategy using surgical lasers and optical fibers is feasible and suggest that the procedure could be used to repair blocked shunts without requiring surgical replacement. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Fiberoptic Delivery of Laser Energy to Remove Occlusions from Ventricular Shunts: Technical Report

Fiberoptic Delivery of Laser Energy to Remove Occlusions from Ventricular Shunts: Technical Report

Fiberoptic Delivery of Laser Energy to Remove Occlusions from Ventricular Shunts: Technical Report W illiam A. Christens-Barry, Ph.D., Michael Guarnieri, Ph.D., Benjamin S. Carson, Sr., M .D. The Johns H opkins U niversity Applied Physics Laboratory (W A C -B ), Laurel, and Department of Neurological Surgery (M G , BSC), Johns Hopkins M edical Institutions, Baltim ore, M aryland OBJECTIVES: Shunts frequently require surgical replacement because occlusions block the ventricular tubing. W e have examined the hypothesis that a surgical laser coupled to an optical fiber can deliver sufficient energy to disrupt the occlusion in situ and thus afford a less invasive method of repair. METHODS: Choroid plexus tissue found in shunts explanted from patients, model tissues such as polyacrylam ide gel, and animal tissues inserted into shunts were examined. Occlusions were fragmented by pulsed laser energy of 2.09-/mm wavelength and 300-microsecond duration delivered via a flexible optical fiber several meters in length. The methods and conditions w ere similar to those likely to be used for preclinical in vivo studies. RESULTS: Short-lived vapor bubbles generated at the fiber tip disrupted occlusions within the shunt and expelled tissue blocking the inflow holes. Energy requirements to disrupt and remove occlusions in vitro were determined. Laser pulse energies and exposure thresholds that cause intentional damage to shunts also w ere determined. C O N C LU SIO N : Laser energies needed to disrupt occlusions were below the energy needed to damage the shunt components. O u r results show that a strategy using surgical lasers and optical fibers is feasible and suggest that the procedure could be used to repair blocked shunts without requiring surgical replacement. (Neurosurgery 4 4 :3 4 5 -3 5 0 , 1999) Keywords: Cerebrospinal fluid shunt, Fiber optics, H yd ro cep halu s, Laser surgery, Pediatric neurosurgery years to coagulate adherent choroid plexus. The technique he 1-year...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199902000-00057
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:Shunts frequently require surgical replacement because occlusions block the ventricular tubing. We have examined the hypothesis that a surgical laser coupled to an optical fiber can deliver sufficient energy to disrupt the occlusion in situ and thus afford a less invasive method of repair.METHODS:Choroid plexus tissue found in shunts explanted from patients, model tissues such as polyacrylamide gel, and animal tissues inserted into shunts were examined. Occlusions were fragmented by pulsed laser energy of 2.09-/mm wavelength and 300-microsecond duration delivered via a flexible optical fiber several meters in length. The methods and conditions were similar to those likely to be used for preclinical in vivo studies.RESULTS:Short-lived vapor bubbles generated at the fiber tip disrupted occlusions within the shunt and expelled tissue blocking the inflow holes. Energy requirements to disrupt and remove occlusions in vitro were determined. Laser pulse energies and exposure thresholds that cause intentional damage to shunts also were determined.CONCLUSION:Laser energies needed to disrupt occlusions were below the energy needed to damage the shunt components. Our results show that a strategy using surgical lasers and optical fibers is feasible and suggest that the procedure could be used to repair blocked shunts without requiring surgical replacement.

Journal

NeurosurgeryOxford University Press

Published: Feb 1, 1999

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