A Decade of Insights: Reevaluating the Use of the Flexible-Fiber CO2 Laser in Brain Tumor Surgery—Efficacy, Challenges, and Lessons Learned

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INTRODUCTION: The introduction of flexible fiber technology in the early 2000s revitalized the interest in the CO2 laser for neurosurgical applications, making it suitable for microsurgical procedures. Despite its widespread use, specific indications for the CO2 laser in neurosurgery remains undefined. This study evaluates the efficacy and limitations of the CO2 laser in brain tumor surgery. MATERIALS AND METHODS: This retrospective observational single-center study analyzed the use of the CO2 laser in intracranial neoplasm surgeries from 2011 to 2021. A total of 94 patients were assessed, focusing on demographics, tumor characteristics, surgical duration, complications, and laser-specific issues. We used a five-tiered scoring system to assess laser effectiveness in both debulking and dissection tasks; with resection extent assessed following established guidelines. RESULTS: The CO2 laser was highly effective in debulking solid tumors, achieving a 76.5% gross total resection rate, while being less effective in softer, highly vascularized tumors. The average effectiveness scores for dissection (2.6±0.8) were significantly lower than for debulking (3.2±1.2). Two major complications were directly associated with laser use. Effectiveness improved over time, particularly in the latter half of the study, and varied across tumor types, with notable utility in meningiomas and vestibular schwannomas but lower scores in glial tumors. CONCLUSIONS: The CO2 laser is a valuable tool in neurosurgery, especially for solid tumors in specific anatomical locations. Careful patient selection is crucial, and the laser complements rather than replaces conventional surgical tools. Ongoing technological advancements suggest broader future applications in neurosurgery.

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