The Treatment of Arteriovenous Malformations of the Brain with the Neodymium: YAG Laser

  • John M. TewJr.
  • W. D. Tobler
  • M. Zuccarello


The introduction of the Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser is the most recent technological adjunct advocated for the treatment of arteriovenous malformations (AVMs). Beck reported that Nd: YAG laser is effective for coagulation of brain tissue [1, 2]. Subsequent preliminary reports concerning the clinical effectiveness of the Nd: YAG laser for coagulation and induction of hemostasis associated with vascular tumors [9, 29], aneurysms [8], and AVMs [7, 8, 31, 34] have varied from enthusiastic to disappointing in content. Blood selectively absorbs the energy emitted by this laser wavelength and thrombosis of vessels can be effectively induced without imparting substantive damage to adjacent brain tissue [32]. Because the operative removal of AVMs of the brain and particularly those arising from the central core remain one of neurosurgery’s major unresolved technical challenges, we have directed our efforts toward technical developments of the Nd: YAG laser as a mode of therapy. We agree with Wharen and colleagues that refinements are necessary [34]. However, our experience in a substantial number of cases of complex AVMs confirms the safety of the device and indicates that it can be of inestimable benefit in the surgical extirpation of some malformations.


Arteriovenous Malformation Posterior Cerebral Artery Carbon Dioxide Laser Homonymous Hemianopsia Surgical Extirpation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Beck OJ (1980) The use of the Nd: YAG and the CO2 laser in neurosurgery. Neurosurg Rev 3: 261–266.PubMedCrossRefGoogle Scholar
  2. 2.
    Beck OJ (1984) The use of the Nd: YAG laser in neurosurgery. Neurosurg Rev 7: 151–157.PubMedCrossRefGoogle Scholar
  3. 3.
    Cushing H, Bailey P (1928) Tumors arising from the blood vessels of the brain: angiomatous malformations and hemangioblastomas. Charles C Thomas, Springfield, Illinois, 219 ppGoogle Scholar
  4. 4.
    Dandy WE (1928) Arteriovenous aneurysms of the brain. Arch Surg 17: 190–243.CrossRefGoogle Scholar
  5. 5.
    Debrun G, Vinuela F, Fox A, Drake CG (1982) Embolization of cerebral arteriovenous malformations with bucrylate. J Neurosurg 56: 615–627.PubMedCrossRefGoogle Scholar
  6. 6.
    Drake CG (1979) Cerebral arteriovenous malformations: Consideration for and experience with surgical treatment in 166 cases. Clin Neurosurg 26: 145–208.PubMedGoogle Scholar
  7. 7.
    Fasano VA (1981) The treatment of vascular malformation of the brain with laser sources. Lasers Surg Med 1: 347–356.PubMedCrossRefGoogle Scholar
  8. 8.
    Fasano VA, Urciuoli R, Ponzio RM (1982) Photocoagulation of cerebral arteriovenous malformations and arterial aneurysms with the neodymium: Yttrium-Aluminum-Garnet or Argon laser: preliminary results in twelve patients. Neurosurgery 11(6): 754–760.PubMedCrossRefGoogle Scholar
  9. 9.
    Fasano VA (1983) Observations on the use of three laser sources in sequence (CO2-Argon-Nd: YAG) in neurosurgery. Lasers Surg Med 2: 199–203.PubMedCrossRefGoogle Scholar
  10. 10.
    Forster DMC, Steiner L, Hakanson S (1972) Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37: 562–570.PubMedCrossRefGoogle Scholar
  11. 11.
    Hilal SL, Michelson JW (1975) Therapeutic percutaneous embolization for extraaxial vascular lesions of the head, neck, and spine. J Neurosurg 43: 275–287.PubMedCrossRefGoogle Scholar
  12. 12.
    Jain KK, Gorisch W (1979) Repair of small blood vessels by Neodymium-YAG laser. Surg 85: 684.Google Scholar
  13. 13.
    Jain KK (1983) Lasers in neurosurgery: a review. Lasers Surg Med 2: 217–230.PubMedCrossRefGoogle Scholar
  14. 14.
    Jain KK (1985) Complications of use of the Neodymium: Yttrium-Aluminum-Garnet laser in neurosurgery. Neurosurgery 16(6): 759–762.PubMedCrossRefGoogle Scholar
  15. 15.
    Kamikawa K, Ohnishi T, Hayakawa T, Yoshimine T, Mochida N, Togo T, Takeuchi K (1979) Evaluation of CO2 laser surgical unit in neurosurgery. In: Laser surgery: Proceedings of the 3rd International Congress for Laser Surgery, Graz, 24-26, 1979, pp 109-114.Google Scholar
  16. 16.
    Kelly PF, Alker GJ, Zoll JG (1982) A microstereotactic approach to deepseated arteriovenous malformations. Surg Neurol 17: 260–262.CrossRefGoogle Scholar
  17. 17.
    Kjellsberg RN, Hanamura T, Davis KR, Lyons SL, Adams RD (1983) Braggpeak Proton-beam therapy for arteriovenous malformations of the brain. N Eng J Medicine 309: 269–274.CrossRefGoogle Scholar
  18. 18.
    Leheta F, Gorisch W (1976) Coagulation of blood vessels by means of argon ion and Nd: YAG laser radiation. In: Kaplan I (ed) Laser surgery I. Jerusalem Academic Press, Jerusalem, pp 178–184.Google Scholar
  19. 19.
    Luessenhop AJ, Spence WT (1960) Artificial embolization of cerebral arteries: report of use in a case of arteriovenous malformation. JAMA 172: 1153–1155.CrossRefGoogle Scholar
  20. 20.
    Luessenhop AJ, Presper JH (1975) Surgical embolization of cerebral arteriovenous malformations through internal carotid and vertebral arteries. J Neurosurg 42: 443–451.PubMedCrossRefGoogle Scholar
  21. 21.
    Michaelson WJ (1979) Natural history and pathophysiology of arteriovenous malformations. Clin Neurosurg 26: 307–313.Google Scholar
  22. 22.
    O’Reilly GV, Colucci VM, Astorian DG, Schoene WC, Clarke RH, Hammerschlag SB (March 1982) Transcatheter fiberoptic laser coagulation of blood vessels. Radiology 142: 777–780.PubMedGoogle Scholar
  23. 23.
    Parkinson D, Bachers G (1980) Arteriovenous malformations: summary of 100 consecutive supratentorial cases. J Neurosurg 53: 285–299.PubMedCrossRefGoogle Scholar
  24. 24.
    Russell WF, Smith RR (1982) Pellet embolization of central nervous system arteriovenous malformations. In: Smith RR, Haerer AF, Russell WF (eds) Seminars in neurological surgery: vascular malformations and fistulas of the brain. Raven Press, New York, pp 101–117.Google Scholar
  25. 25.
    Samson D (1983) Surgical treatment of intracranial arteriovenous malformations. Tex Med 79: 52–59.PubMedGoogle Scholar
  26. 26.
    Sang UH, Wilson CB (1975) Surgical treatment of intracranial vascular malformations. West Med J 112: 175–183.Google Scholar
  27. 27.
    Stein BM, Wolpert SM (1980) Arteriovenous malformations of the brain. Parts I and II: Current concepts and treatment. Arch Neurol 37: 1–5, 69-75Google Scholar
  28. 28.
    Steiner L, Leksell L, Forster DMC, Greitz T, Backlund EO (1974) Stereotactic radiosurgery in intracranial arterio-venous malformations. Acta Neurochir (Wien) [Suppl] 21: 195–209.Google Scholar
  29. 29.
    Tekeuchi J, Handa H, Taki W, Yamagami T (1982) The Nd: YAG laser in neurological surgery. Surg Neurol 18(2): 140–142.CrossRefGoogle Scholar
  30. 30.
    Tew JM Jr, Tomsick TA, Lukin RA (1984) Applications of interventional neuroradiology in the treatment of arteriovenous malformation and other vascular disorders of the brain. In: Neurosurgeons, Vol. 4, Proceedings of The Japanese Congress of Neurological Surgeons, Osaka, Japan, pp 331-356, Japan Upjohn Ltd.Google Scholar
  31. 31.
    Tew JM Jr, Tobler WD (1986) Present status of lasers in neurosurgery. In: Symon L et al (eds) Advances and technical standards in neurosurgery, Vol 13. Springer, Wien New York, pp 3–36.CrossRefGoogle Scholar
  32. 32.
    Troupp H, Marttila I, Halonen V (1970) Arteriovenous malformations of the brain: prognosis without operation. Acta Neurochir (Wien) 22: 125–128.CrossRefGoogle Scholar
  33. 33.
    Wharen RE Jr, Anderson RE, Scheithauer B, Sundt TM Jr (1984) The Nd:YAG laser in neurosurgery. Part l. Laboratory investigations: dose-related biological response of neural tissue. J Neurosurg 60: 531–539.PubMedCrossRefGoogle Scholar
  34. 34.
    Wharen RE Jr, Anderson RE, Sundt TM Jr (1984) The Nd:YAG laser in neurosurgery. Part 2. Clinical studies: an adjunctive measure for hemostasis in resection of arteriovenous malformations. J Neurosurg 60: 540–547.PubMedCrossRefGoogle Scholar
  35. 35.
    Wolpert SM, Stein BM (1975) Catheter embolization of intracranial arteriovenous malformations as an aid to surgical excision. Neurorad 10: 73–85.Google Scholar

Copyright information

© Springer-Verlag/Wien 1989

Authors and Affiliations

  • John M. TewJr.
    • 1
  • W. D. Tobler
    • 1
  • M. Zuccarello
    • 1
  1. 1.Department of Neurosurgery, College of MedicineUniversity of CincinnatiCincinnatiUSA

Personalised recommendations