Comparison of Er:YAG and 9.6-microm TE CO(2) lasers for ablation of skull tissue

BACKGROUND AND OBJECTIVE: Craniotomy by using a drill and saw frequently results in fragmentation of the skull plate. Lasers have the potential to remove the skull plate intact, simplifying the reconstructive surgery. STUDY DESIGN/MATERIALS AND METHODS: Transverse-excited CO(2) lasers operating at the peak absorption wavelength of bone (lambda = 9.6 microm) and with pulse durations of 5-8 microsec, approximately the thermal relaxation time in hard tissue, produced high ablation rates and minimal peripheral thermal damage. Both thick (2 mm) and thin (250 microm) bovine skull samples were perforated and the ablation rates calculated. Results were compared with Q-switched and free-running Er:YAG lasers (lambda = 2.94 microm, tau(p) = 0.5 microsec and 300 microsec). RESULTS: The CO(2) laser produced ablation rates of up to 60 and 15 microm per pulse for thin and thick sections, respectively, and perforated thin and thick sections with fluences of less than 1 J/cm(2) and 6 J/cm(2), respectively. There was no discernible thermal damage and no need for water irrigation during ablation. Pulse durations > or =20 microsec resulted in significant tissue charring, which increased with the pulse duration. Although the free-running Er:YAG laser produced ablation rates of up to 100 microm per pulse, fluences of 10 J/cm(2) and 30 J/cm(2) were required to perforate thin and thick samples, respectively, and peripheral thermal damage measured 25-40 microm. CONCLUSIONS: In summary, the novel 5- to 8-microsec pulse length of the TE CO(2) laser is long enough to avoid a marked reduction in the ablation rate due to plasma formation and short enough to avoid peripheral thermal damage through thermal diffusion during the laser pulse. Furthermore, in vivo animal studies with the TE CO(2) laser are warranted for potential clinical application in craniotomy and craniofacial procedures.