Novel laser tissue-soldering technique for dural reconstruction

Object. The goal of this study was to use a modified version of the CO ₂ laser-soldering system to develop a simple and reliable technique for the repair of dural defects after excision of brain tumors. Methods. The authors used a CO₂ fiber optic laser system that they had developed for heating, monitoring, and controlling tissue temperature in situ and in real time, thereby reducing damage to the brain parenchyma. They adapted the system for dural closure by using free fascial grafts in a porcine model. Measures for estimation of reconstruction quality included visual assessment under magnification and direct measurements of adhesive strength and cerebrospinal fluid leak (CSF) pressure. Reliable soldering was achieved in 54 of 57 experiments, providing a 95% success rate. The average peak adhesive strength was 82 ± 3 mN/cm². The measured leak pressure of the fascia-dura mater bond was 66 ± 5 mm Hg. Conventional suturing performed using Prolene stitches resulted in immediate CSF leakage from areas between the stitches and from the area of the needle hole itself. Conclusions. Fascia-dura mater soldering using the CO² laser is feasible and may support CSF pressure up to six times higher than normal intracranial pressure. Findings of this study may provide a basis for the development of new tools for dural reconstruction.