Laser Cutting Will Make Skull Surgeries Much Safer

If the brain starts to swell after a stroke, surgery is often the only treatment option – one in which the physicians open the patient’s cranial vault. Up to now, they would reach for the drill and the saw. Soon, a laser beam will cut the bone and lower the risk.

A stroke strikes suddenly, and if the infarction is a major one, this may cause the brain to swell. The pressure in the cranial cavity increases, perfusion to the brain diminishes and the brain suffers further damage. To protect it from contusions, the surgeon will often open the patient’s cranial vault – this is referred to as a release craniotomy. Until now, surgeons cut the cranial bones mechanically, that is, with a trephine. However, that approach comes with a truly high risk to the patient: By using the trephine, the surgeon could inadvertently injure the meninges, which could then lead to meningitis and, in the worst case scenario, to death.

Researchers at the Fraunhofer Institute for Photonic Microsystems IPMS in Dresden, Germany, together with their colleagues at the Fraunhofer Institute for Laser Technology ILT and at Integrated Circuits IIS, intend to lower this risk by replacing the trephine with a high energy femto-second laser.

The laser beam is fed into a special hand piece through an articulated mirror arm. Its core consists of two new types of micro-mirrors that the researchers at IPMS developed. The first makes the cranial vault incision; it directs the laser beam dynamically across the cranial bones. The second adjusts any wrong positioning. The special thing: The components are miniaturized, but can tolerate up to 20 watts of laser output – which is about two hundred times more than conventional micro-mirrors. These can already reach their limits at 100 milliwatts, depending on their specific design. In addition, at 5 x 7 or 6 x 8 millimeters, they are very large and thus, can also guide large diameter laser beams. By comparison: Conventional micro-mirrors measure from 1 to 3 millimeters.

How did the researchers achieve this? “Whereas the silicon panel in conventional micro-mirrors is mirrored by an aluminum layer measuring a hundred nanometers thick, we applied highly-reflective electric layers to the silicon substrate,” explains Sander. Therefore, in the visible spectral range, the mirror reflects not merely 90 percent of the laser beam, like typical components, but 99.9 percent instead. Much less of the high-energy radiation penetrates into the substrate. That means the mirror “discerns” less of the laser beam and tolerates markedly greater power. The challenge for the researchers primarily lay in capturing this high power coating onto the silicon substrate, just a few micrometers thin, that is commonplace in microsystems technology.