Applications and restrictions of diode-laser for gliomas surgeries – current concepts and a review

Introduction: Gliomas have a significant incidence among all brain tumors and have a great morbidity and mortality. Neurosurgical approach at the proper time is essential for a good control of the disease. Maximum safe resection is an important goal for glial tumors and so, many resources should be used to help achieve this principle. Laser therapy have been used since decades ago. Nowadays different types of this technology are available. Diode lasers penetrate comparative depths into tissue because they are poorly absorbed by water. The photo thermal properties of diode laser were used to promote tissue desiccation, shrinkage and hemostasis.

Methods: A prospective research is being develop after Ethics Committee approval. Patients which have as main diagnostic hypothesis glial tumors will be submitted to microsurgery approach with diode laser assistance and fluorescence guided surgery (Sodium Fluorescein). Intraoperative time, post-operative CT status, neurological evaluation and blood transfusion requirement will be accessed and compared with surgery without these resources. Literature review at Pubmed database was also performed.

Results: One patient with a huge low grade left frontal tumor and one with a left supra marginal gyrus high grade tumor were operated. Microsurgical approach was performed with diode-laser assistance. It was observed that the tumor could be more easily and faster dissected from the normal brain tissue, avoiding too much retraction. Besides, the tumor bed hemostasis at the final was more effective and quickly without commitment of the surrounding normal tissue. At the patient with the low-grade tumor it was performed a supratotal resection and at the high-grade lesion a subtotal (about 90%) resection. No postoperative complications considering CT and neurological examination occurred and no blood transfusion was required.

Conclusions: Diode-laser therapy could be a valuable resource for gliomas surgeries helping the tumor removal and the final hemostasis decreasing intraoperative time and improving maximal safe resection.