Search Results (130)

Objectives: This review examines the efficacy of each laser type in the field of periodontal surgery and analyzes published articles that focus on the use of lasers in periodontal surgery. Methods: Automatic and manual searches were made in 3 separate databases (PubMed, Embase, and Cochrane) with the aim of finding all published articles of the last 15 years up until December 2023 that describe the clinical manipulation of diode, erbium:yttrium-aluminum-garnet (Er:YAG), erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG), neodymium yttrium-aluminum-garnet (Nd:YAG), and carbon dioxide (CO₂) lasers for periodontal surgical procedures in humans. Results: A total of 18 studies were selected for inclusion, all of which compared the usage of a laser type to conventional periodontal surgical techniques with their main follow-ups being in 3, 6, or 9 months. Conclusions: There are a variety of laser types, each with different settings and wavelengths, that can be applied to the established aspects of resective and regenerative periodontal surgeries. A significant majority of the publications, 10 of the 12 studies, that include diode lasers as an adjunctive show an improvement in clinical results compared to traditional surgical techniques alone, while 2 articles studied the Er:YAG laser and 1 article studied the Er,Cr:YSGG laser, with all 3 of them failing to completely test their therapeutic capabilities and indicating similar results to conventional surgery. The Nd:YAG laser was featured in 3 studies, with 1 study showing superior results for the laser group, another study showing the negative influence of the laser, and the 3rd study being inconclusive. The CO₂ laser was used in 1 study and showed better clinical results for the laser group. Diode lasers have been proven to produce additional therapeutic results, but there is a need for further investigation of erbium family lasers along with the Nd:YAG and CO₂ lasers, as the current provided literature contradicts their potential healing capabilities. Full article

Objectives: A Ziemer LDV Z8 femtosecond laser (FSL) was used to obtain optimal cutting parameters with precise settings for donor and recipient preparations for Bowman layer transplantation. Methods: Of 48 human research corneas examined, 32 were used for Bowman layer preparation (donor) and 16 for pocket preparation (recipient) using the LDV Z8 FSL. The cutting thickness of the Bowman layer, pocket depth, and corresponding laser settings were varied. The quality of sections was evaluated based on the occurrence of adhesions, bridges, or perforations. Histological specimens were prepared and analyzed. Results: Preparation of the Bowman layer and recipient pocket was possible using all selected settings. The thinner the Bowman layer and the more superficial the pocket preparation, the higher the risk of perforation was. Considering the fact that the Bowman layer was cut as thinly as possible, a Bowman layer thickness of 30 µm showed a 100% success rate. Bowman layers cut at 25 µm had a lower success rate (50%). The pocket depth of 150 µm showed a 100% success rate in the preparation. Histological processing revealed smooth, precisely cut edges of Bowman layers and pockets. Implantation into the pocket was successful in all cases. Conclusions: Both Bowman layer and pocket preparation were technically and surgically feasible using the LDV Z8 FSL, and the prepared Bowman layers were thinner than those reported in previous studies. The optimal Bowman layer thickness was 30 µm, and a resection depth of 150 µm was used to prepare the pockets safely. Full article

The development of an intelligent ultrasonic aspirator controlled by a fiber-optic neoplasm sensor that detects 5-aminolevulinic acid-derived porphyrin fluorescence presents a significant advancement in glioma surgery. By leveraging the fluorescence phenomenon associated with 5-aminolevulinic acid in malignant neoplasms, this device integrates an excitation laser and a high-sensitivity photodiode into the tip of an ultrasonic aspirator handpiece. This setup allows for real-time tumor fluorescence detection, which in turn modulates the aspirator’s power based on fluorescence intensity. Preliminary testing demonstrated high sensitivity, with the device capable of differentiating between weak, strong, and no fluorescence. The sensor sensitivity was comparable to human visual perception, enabling effective tumor differentiation. Tumors with strong fluorescence were effectively crushed, while the aspirator ceased operation in non-fluorescent areas, enabling precise tissue resection. Furthermore, the device functioned efficiently in bright surgical environments and was designed to maintain a clean sensor tip through constant saline irrigation. The system was successfully applied in a surgical case of recurrent glioblastoma, selectively removing tumor tissue while preserving surrounding brain tissue. This innovative approach shows promise for safer, more efficient glioma surgeries and may pave the way for sensor-based robotic surgical systems integrated with navigation technologies. Full article

(1) Background: Osteonecrosis of the jaw (ONJ) remains a challenging condition without a universally accepted treatment protocol. Surgical therapy, particularly Er:YAG laser-assisted surgery, has shown more predictable long-term results compared with non-surgical options. However, the identification of resection margins in ONJ surgery is complex and currently relies on the surgeon’s intraoperative assessment, without standardization. Bone autofluorescence (AF) has been proposed as an intraoperative diagnostic tool for visualizing necrotic bone; under VELscope (LED Medical Diagnostics Inc., Barnaby, BC, Canada) illumination, healthy bone exhibits hyperfluorescence, while pathological bone appears dark brown/black (loss of autofluorescence, LAF). (2) Methods: 22 patients with ONJ requiring surgical therapy were included. After bone exposure, VELscope system was used to induce and visualize bone AF. Areas exhibiting absent or pale AF were identified as necrotic and removed; additional samples were collected from adjacent hyperfluorescent regions. (3) Results: Histopathologic evaluation of 56 specimens were conducted; 35 hypofluorescent samples were found to be necrotic bone tissue; in the 21 hyperfluorescent samples, 86% demonstrated normal, vital bone. The correlation between fluorescence and bone vitality was highly significant (p < 0.0000001). (4) Conclusions: Our data show that AF-guided surgical resection, combined with Er:YAG laser-assisted surgery, may improve clinical outcomes. Full article

Sturge–Weber Syndrome (SWS) is a rare neurocutaneous disorder caused by a somatic nonsynonymous mosaic mutation most commonly in the GNAQ gene (G protein guanine Nucleotide-binding protein Alpha subunit q). SWS is characterized by capillary-venous malformations in the brain and eyes and a characteristic facial port wine (PW) birthmark (previously called port wine stain/PWS) in the head/neck region. Clinical manifestations vary and include epilepsy, stroke-like episodes, migraine headaches, cognitive delays, glaucoma, ocular vascular anomalies, heterochromia of the iris, visual field defects, and endocrine disorders like growth hormone deficiency or central hypothyroidism. The pathognomonic findings seen in neuroimaging with magnetic resonance imaging (MRI) include the presence of unilateral intracranial leptomeningeal angiomatosis, typically ipsilateral to the facial birthmark. SWS does not currently have a definitive cure, and management strategies focus on symptomatic management such as anti-seizure medications, limited surgical resection of the epileptogenic tissue or hemispherectomy for cases of drug-resistant epilepsy (DRE), selective photo-thermolysis of the PWS using a pulsed dye laser, and the medical and/or surgical management of glaucoma. In addition to these symptomatic treatments, the use of preventive, modifying, or stabilizing treatments like low-dose aspirin in reducing the frequency and severity of seizures and stroke-like events and the use of newer therapies like cannabidiols and mTOR inhibitors are being reviewed and have shown promising early results. This comprehensive narrative review summarizes the current literature on clinical management strategies, ongoing research studies, and future directions in the diagnosis and management of SWS. Full article

Background/Objectives: Primary brain tumors are difficult to identify intraoperatively due to their infiltrative character in the marginal zone. Several optical methods have been suggested. Of these, 5-ALA-induced fluorescence visualized through a microscope is the most common. The aim is to present an investigational probe-based optical system and its translation for clinical use, summarize previous studies, and give examples of clinical implementations during resection and burr hole biopsies. Methods: The FluoRa system combines 5-ALA fluorescence spectroscopy with laser Doppler flowmetry (LDF). Probe designs are available for brain tumor resection (hand-held probe) or burr hole needle biopsies (frame-based or navigated). The outer cannulas of biopsy needles are modified with an opening at the tip for simultaneous use with optical probes during insertion along the trajectory. An updated version of FluoRa is introduced and experimentally investigated. Results: Probe-based fluorescence spectroscopy has been successfully translated for clinical use and applied during brain tumor resection (n = 75) and burr hole needle biopsies (n = 47). Forward-looking optical measurements through the biopsy needle reduce the number of trajectories (28/27) compared to prior to insertion (28/20), at the same time that the target for tissue sampling can be identified in situ. Additionally, increased microcirculation is identified along the trajectory with LDF. This is accomplished with FluoRa. Conclusions: Intraoperative probe-based spectroscopic measurements quantify 5-ALA fluorescence and thus identify glioblastoma and lymphoma tissue in situ during resection and burr hole needle biopsies. Full article

Brain tumors, both primary and metastatic, represent a significant global health burden due to their high incidence, mortality, and the severe neurological deficits they frequently cause. Gliomas, especially high-grade gliomas (HGGs), rank among the most aggressive and lethal neoplasms, with only modest gains in long-term survival despite extensive molecular research and established standard therapies. In neurosurgical practice, maximizing the extent of safe resection is a principal strategy for improving clinical outcomes. Yet, the infiltrative nature of gliomas often complicates the accurate delineation of tumor margins. Confocal laser endomicroscopy (CLE), originally introduced in gastroenterology, has recently gained prominence in neuro-oncology by enabling real-time, high-resolution cellular imaging during surgery. This technique allows for intraoperative tumor characterization and reduces dependence on time-consuming frozen-section analyses. Recent technological advances, including device miniaturization and second-generation CLE systems, have substantially improved image quality and diagnostic utility. Furthermore, integration with deep learning algorithms and telepathology platforms fosters automated image interpretation and remote expert consultations, thereby accelerating surgical decision making and enhancing diagnostic consistency. Future work should address remaining challenges, such as mitigating motion artifacts, refining training protocols, and broadening the range of applicable fluorescent probes, to solidify CLE’s role as a critical intraoperative adjunct in neurosurgical oncology. Full article

Objective: Colorectal pulmonary metastasis is the most common resected metastatic disease of the lung. Pulmonary metastasectomy (PM) for colorectal oligometastases is a well-established intervention with curative intent. Local recurrence at the resection site in the lung is a problem, with an impact on survival. The use of a 1320 nm neodymium:yttrium aluminum garnet (Nd:YAG) laser causes the vaporization and coagulation at the resection line and thereby increases safety margins around the nodule. We aimed to evaluate the local recurrence rate after laser-assisted pulmonary metastasectomy (LPM) for colorectal metastases. Methods: We conducted a retrospective analysis of 49 patients treated with laser-assisted pulmonary metastasectomy for 139 metastatic nodules from colorectal cancer from 2010 to 2018. All nodules were resected using Nd:YAG 1320 nm laser, aiming for a safety margin of five mm. The minimum follow-up time after PM was 24 months. Results: Local intrapulmonary recurrence developed at 7 of the 139 (5.0%) resection sites in 5 of the 49 patients (10.2%). Microscopically incomplete resection was a significant risk factor for recurrence (p = 0.023). Larger nodule size (>12 mm) negatively impacted local recurrence (p = 0.024). Nodules larger or equal to 12 mm in size also lowered the patients’ probability of survival by 67.29% (HR: 0.3271, 95% CI: 0.1265–0.846, p = 0.018). Conclusions: The rate of local recurrence at the resection site after LPM for colorectal metastases is low. Complete resection is a positive predictor of survival without local recurrence. Microscopic complete resection with the addition of vaporization and coagulation at the resection margin seems to be sufficient to prevent local recurrence. However, larger nodules may require larger safety margins. Full article

Background: Temporal lobe epilepsy is the most common pharmaco-resistant type of epilepsy. The chance of obtaining seizure freedom after resective surgery in pharmaco-resistant mesial temporal lobe patients (mTLE) is significantly higher compared to pharmaceutical treatment (at least 50–60% compared to less than 15%). However, some factors (e.g., craniotomy) may prevent epilepsy patients undergoing surgery. A recent advancement in epilepsy surgery, i.e., magnetic resonance guided laser interstitial thermal therapy (MRgLITT), has become an attractive alternative for performance of selective amygdala-hippo-campectomy, especially because of its minimal invasiveness. Among other medial temporal lobe structures, the hippocampus is particularly important for successful processing of vestibular inputs. Nevertheless, it is still unclear whether mTLE patients who underwent MRgLITT perform worse on vestibular-dependent tests, including balancing, spatial orientation and rotational memory. Methods: Nine patients (Age 40.1 ± 14.5; 2 females) underwent vestibular-dependent assessments before and after MRgLITT using the following test battery: (I) clinical balancing test (CBT), (II) triangle completion test (TCT) and (III) rotational memory test (RM). Results: We found significant improvement from pre- to post-surgery in the vestibular-dependent spatial orientation test, namely in the wheelchair condition of the triangle completion test. Additionally, the obtained effect sizes were medium to large in favor of post-surgery assessment for the majority of conditions in the three tests applied in this study, indicating that the assessment of a larger number of patients could also, potentially, lead to significant results in these cases. Conclusions: This plausibility study is the first to assess vestibular-dependent balancing, spatial orientation and rotational memory functions before and after MRgLITT in mTLE patients. Even with a small sample of nine patients, significant changes and medium to high effect sizes in favor of surgery were observed. Nevertheless, prospective studies with larger sample sizes are necessary for appropriate estimation of MRgLITT effectiveness in these functional domains. Full article

The increasingly widespread use of stereo-EEG in the pre-surgical evaluation has led to greater recognition of the insula as both a source and surgical target for drug-resistant epilepsy. Clinicians have long appreciated the challenges of diagnosing and treating seizures arising from the insula. Insular-onset seizures present with a wide variety of semiologies due to its dense and complex integration with other brain structures, resulting in the insula’s reputation as the “great mimicker.” Surgical access to the insula is guarded by the overlying frontal, temporal, and parietal opercula and requires careful negotiation of the Sylvian fissure, the vascular candelabra of the middle cerebral artery, and protection of crucial white matter structures (e.g., corona radiata). Despite these difficulties, open surgical intervention for insular epilepsy is associated with favorable seizure control rates, surpassing those achieved with less-invasive alternatives (e.g., laser ablation). Technical nuances that minimize the risk of adverse functional outcomes following open insular resection (especially hemiparesis) are of tremendous value to the epilepsy surgeon. Here, we review the literature on hemiparesis secondary to insular resection and detail strategies for achieving safe and thorough resection of the insula, with emphasis placed on the posterior insula. We supplement this review with four illustrative cases in which focal, drug-resistant epilepsy was managed via open insular resection with no resultant permanent hemiparesis. Technical insights accumulated through these cases are highlighted. Full article

Transurethral enucleation (TUE) has revolutionized the management of benign prostatic obstruction (BPO), offering a minimally invasive solution with superior efficacy across all prostate sizes. This review explores the advancements in TUE techniques, including Holmium Laser Enucleation of the Prostate (HoLEP), Thulium Laser Enucleation of the Prostate (ThuLEP), and bipolar enucleation, highlighting their clinical benefits, safety profiles, and long-term outcomes. Compared to traditional approaches such as transurethral resection of the prostate (TURP) and open prostatectomy, TUE has been associated with reduced complication rates, shorter recovery times, and durable symptom relief. The manuscript also examines patient-centered considerations, such as quality of life improvements and preservation of sexual function, which contribute to high patient satisfaction. Furthermore, the economic advantages of TUE, driven by reduced retreatment rates and healthcare costs, underscore its value for both patients and healthcare systems. Emerging innovations, including artificial intelligence (AI), promise to further enhance procedural planning, surgical precision, and training pathways. Efforts to expand global access through cost-effective adaptations like bipolar enucleation and targeted training initiatives are paving the way for wider adoption of TUE. With its adaptability, technological advancements, and focus on patient outcomes, TUE is poised to become the global standard of care in BPO management. Full article

Objectives: The aim of this article is to examine the effectiveness and capabilities of laser use in periodontal surgical therapy by analyzing the existing literature that focuses on laser use alone or as a supplement to the already existing periodontal surgical techniques, comparing it to conventional periodontal surgical therapy, with the intent to reach a better understanding of the efficiency and therapeutic potential of lasers in periodontal surgery. Methods: An electronic search of the PubMed, Embase, and Cochrane databases was performed between October 2023 and December 2023 to identify all of the articles published in the last 15 years and investigate information about the application of Diode, Erbium:yttrium–aluminum–garnet (Er:YAG), Carbon Dioxide (CO₂), and Neodymium yttrium–aluminum–garnet (Nd:YAG) lasers to surgical periodontal therapy in human trials. Results: The database search yielded 18 studies. All of the databases showed a clinical improvement in pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), and bleeding on probing (BOP) in both the test and control groups, with results from five articles showing statistically better PD reduction in the laser group compared to the control group. CAL gain was statistically higher in the laser group in six articles, while one study indicated better PD and CAL results in the control group. Improved GR reduction with a laser was noted in two articles, while one article reported a negative influence from a laser in GR. BOP was significantly better with laser in one study, while the remaining two studies reported the same results as the control group. Conclusions: Laser application in resective surgery exhibits additional benefits to the already established techniques, while in regenerative surgery, more investigation is needed. Diode laser use in periodontal surgery is already widespread and shows clinical efficacy, while low-level laser therapy (LLLT) has an exceptional potential for a variety of applications, promoting better wound healing and less post-surgical complications. However, more trials and studies are needed to further examine the maximum efficiency of each laser type in periodontal surgical therapy. Full article

Hypothalamic hamartomas (HH) are infrequent, non-neoplastic malformations of the hypothalamus with heterogeneous clinical features, with symptoms including gelastic seizures, central precocious puberty, and cognitive or behavioral deficits. This narrative review synthesizes current knowledge regarding the etiology, clinical manifestations, diagnostic advances, and therapeutic approaches for HH. Genetic insights highlight the role of postzygotic mosaicism and dysregulated Sonic Hedgehog signaling in HH development, emphasizing their relevance in potential therapeutic strategies. Diagnostic modalities such as MRI, PET, and SEEG are pivotal in identifying and characterizing HHs, enabling precise treatment planning. Therapeutic interventions span pharmacological, surgical, and neuromodulatory approaches. While surgical approaches, such as transcallosal resection or stereotactic radiosurgery, can offer considerable seizure control, newer modalities, such as laser interstitial laser thermal therapy (LITT) as well as stereotactic radiofrequency thermocoagulation, prioritize minimizing both cognitive and behavioral sequelae. The use of pharmacologic management and neuromodulation provides adjuvant benefits, specifically in drug-resistant epilepsy; despite progress, limitations still remain, including variability of outcomes and not enough long-term studies. This review underscores the need for multidisciplinary care and advanced research to optimize outcomes and improve the quality of life for patients with HH. Full article

The primary method of treatment for patients suffering from drug-resistant focal-onset epilepsy is resective surgery, which adversely impacts neurocognitive function. Radio frequency (RF) ablation and laser ablation are the methods with the most promise, achieving seizure-free rates similar to resection but with less negative impact on neurocognitive function. However, there remains a number of concerns and open technical questions about these two methods of thermal ablation, with the primary ones: (1) heating; (2) hemorrhage and bleeding; and (3) poor directionality. Irreversible electroporation (IRE) is a proven method of focal ablation, which circumvents all three of the primary concerns regarding focal RF and laser ablation. Here, we demonstrate the in vivo application of a flexible implant with organic electrodes for focal ablation of epilepsy foci using high-frequency IRE (H-FIRE) in mice. Our results show that local, targeted ablation is possible in the close neighborhood of the electrode, paving the way for the clinical application in the treatment of focal epilepsy. Full article

Background: Benign prostatic hyperplasia (BPH) is a frequent condition in ageing men. Surgery is recommended for severe BPH symptoms and BPH-related complications. TURP is the reference standard for BPH surgery, but carries a risk of bleeding, which can lead to significant perioperative morbidity and mortality. To reduce bleeding during TURP, antifibrinolytic agents like tranexamic acid (TXA) have been studied. We aim to review the current evidence regarding TXA use during transurethral BPH surgery. Objective: This review aims to assess the efficacy and safety of tranexamic acid in reducing bleeding during transurethral benign prostatic hyperplasia surgery. Methods: Major clinical research databases such as PubMed, Cochrane Central Register of Controlled Trials, EBSCO, Scopus, Google Scholar, and Web of Science were searched from 2012 to 2022 for randomised controlled trials (RCTs) comparing the use of TXA to placebo in transurethral BPH surgery using the PICOS format. We included RCTs without language restrictions that assessed intraoperative blood loss, transfusion rates, haemoglobin levels, length of hospital stay, postoperative thromboembolic events, and 30-day perioperative mortality as outcomes. The quality assessment of the included studies was performed using the Cochrane risk-of-bias tool, RoB 2, for randomised studies. Results: A total of six RCTs, which included 456 patients, were eventually included in the meta-analysis. The results showed that tranexamic acid is beneficial in reducing blood loss and minimising changes in haemoglobin levels during transurethral resection of the prostate. However, it does not lessen the need for blood transfusions or shorten the hospital stay. Conclusions: Tranexamic acid is useful in decreasing blood loss and reducing changes in haemoglobin in patients undergoing transurethral resection of the prostate. Its utility during BPH surgery in low-resource settings where the latest haemostatic enucleation techniques, such as holmium and GreenLight laser enucleation, may not be readily available needs further evaluation. Full article