By R. E. Anderson, J. E. Boggan, L. J. Cerullo, M. C. Chan, G. J. Dohrmann, M. S. B. Edwards, V. A. Fasano, J. M. Gilsbach, A. Harders, R. M. Ikeda, P. J. Kelly, E. R. Laws Jr., G. Lee, T. Letardi, D. T. Mason, C. R. Neblett, R. W. Rand, A. Renieri, I. L. Ri

Since the advent of electrosurgery the ideas of surgical procedure at the anxious procedure have undergone extra advancements (bipolar coagulation, microscope), no matter if the technique used to be no longer considerably changed. this day, laser represents a brand new "discipline", because it deals a brand new approach of appearing all simple maneuvers (dissection, demolition, hemostasis, vessel sutures). additionally, laser deals the potential of a distinct maneuver, specifically relief of the quantity of a tumoral mass via vaporization. Its program isn't constrained to conventional neurosurgery yet extends additionally to stereotactic and vascular neurosurgery. Laser surgical procedure has additionally inspired the anesthesiologic suggestions. even as new instrumentation has been brought: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. i've got had the opportunity to make use of those new applied sciences all at a time and feature come to the belief that we face the sunrise of a brand new technique which has already proven its validity and shortage of inconveniences, and whose item is to extend the precision of neurological surgical procedure. The technological improvement remains to be happening, and a few advancements are to be foreseen. Laser scalpel is splitting the preliminary laser surgical procedure into NO­ contact and contact surgical procedure with laser. As new instrumentarium may be built, a variable and tunable beam turns into to be had. for instance, in many years unfastened Electron Laser will additional upload to the development during this field.

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The first gas laser, a helium-neon laser, was developed by Javan, Bennet and Herriot in 1961 7• In the same year, Johnson and Naussau developed the Nd: YAG laser. In 1964 Patel created the CO 2 laser for Bell laboratories 12. Argon laser was introduced around the same time. The first clinical uses of laser were those of the argon laser for retinal detachment in 1965 by L'Esperance 3• As a surgical instrument in neurosurgery the laser beam (Ruby Laser) was used for the first time by Rosomoff in 1965 in patients with gliomas 14.

In this case they were a sign of a reactive hyperemia after the brain spatula pressure was released 35 Intraoperative Dopplersonography MINOR STENOSIS 8 6 4 2 f\ MODERA TE STENOSIS SEVERE STENOSIS 6 4 2 0 ~ J ~ Y ) /'~ Fig. 6. Flow pattern of experimentally induced stenoses of a microvessel (common carotid artery of the rat; diameter 1 mm). Three different grades of stenoses can be distinguished according to Doppler criteria: 1. slight narrowing with a reduction below 60% of the cross sectional area with locally accelerat~d flow velocities; 2.

McDonnell, D. , 1979: The Doppler ultrasonic flowmeter as an adjunct to operative management of cerebral arteriovenous malformations. Surg. Neurol. 11, 345-347. 25. Jorgensen, J. , Campau, D. , Baker, D. , 1973: Physical characteristics and mathematical modelling of the pulsed ultrasonic flowmeter. Med. BioI. Engng. 12,404-421. 26. , 1970: Analysis of ultrasonic blood rheogram by the sound spectrograph. Jap. Circulat. J. 34, 1035-1045. 27. , 1984: personal communication. 28. McLeod, F. , 1967: A directional Doppler flowmeter.

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