Application of a Novel Scanner-Assisted Carbon Dioxide Laser System (SMARTXIDE2) for Neurosurgery

Introduction: Despite potential advantages, a broad diffusion of the CO₂ laser for neurosurgical procedures has been historically precluded by operative limitations, such as its cumbersome design, the bulky set-up, and lower optical quality of the micromanipulators. Nonetheless, in the last decades, significant technologic improvements of CO₂ lasers, together with a better ergonomics and quality of accessories, have made CO₂ laser surgery easier and reproducible. The introduction of surgical microscanners, in particular, has allowed to perform a safer, more precise and faster laser microsurgery, while having a perfect view of the operating field (being a noncontact technique). Hereby, we report our preliminary surgical experience with the laser SmartXide2 CO₂ scanning aided laser system, developed by DEKA (Calenzano, Italy).

Materials and Methods: We treated 10 patients suffering from various lesions (two vestibular schwannomas, two brain metastases, two gliomas, one petroclival and one foramen magnum meningiomas, one spinal neurinoma, and one spinal meningioma) with the aid of the SmartXide2 CO₂ laser system to evaluate its potential and benefits in different neurosurgical scenarios.

The laser system was a DEKA Smartxide2 60W, equipped with the high precision micromanipulator (Easyspot Hybrid version), coupled with a surgical scanner (HiScan Surgical) and connected to a Leica M720 OH5 (Leica Microsystems GmbH, Wetzlar, Germany) neurosurgical microscope through a dedicated adapter.

The focal length of the microscope was set on 300-mm EFL and the CO₂ laser was focused by means of the micromanipulator's zoom on the plane of view, to produce the best effect on tissue. At this focal length the micromanipulator produces a spot of 190 μm, thus being highly precise and effective in ablation and cut.

Results: The CO₂ laser was used, together with the traditional neurosurgical instruments, in every step of the procedures, from the initial pial incision for intra-axial tumors, as well as from the early extra-axial lesions debulking, to the progressive ablation and removal of the lesions, and, at the end of the operations, for the hemostasis of the surgical cavity. No injury to the surrounding neurovascular structures was observed. In particular, in the vestibular schwannomas, the CO₂ laser allowed a safe removal of the tumors around the VII to VIII complex and the lower cranial nerves. Immediate postoperative neuroimaging always confirmed the complete tumor removal, and showed a marked reduction of the preoperative surrounding edema with no evidence of cerebral/medullary contusions.

Conclusion: In our experience, the SmartXide2 CO₂ laser, coupled with Easyspot Hybrid and Hiscan Surgical, turned out to be a suitable system for the resection of different cerebral and spinal lesions. It is an effective and precise tool to perform different neurosurgical steps and procedures. Moreover, having no consumable accessories is also cost effective. Therefore, the SmartXide2 CO₂ laser may represent, in selected cases, a helpful and safe surgical instrument. It addresses some of the ergonomic limitations of the laser systems and is able to cut/ablate and coagulate the tissue at the same time, with minimal lateral thermal spread, thus preserving the surrounding neurovascular structures.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021