Application of shock waves as a treatment modality in the vicinity of the brain and skull

Object. Shock waves have not previously been used as a treatment modality for lesions in the brain and skull because of the lack of a suitable shock wave source and concerns about safety. Therefore, the authors have performed experiments aimed at developing both a new, compact shock wave generator with a holmium:yttrium-aluminum-gamet (Ho:YAG) laser and a safe method for exposing the surface of the brain to these shock waves. Methods. Twenty male Sprague-Dawley rats were used in this study. In 10 rats, a single shock wave was delivered directly to the brain, whereas the protective effect of inserting a 0.7-mm-thick expanded polytetrafluoroethylene (ePTFE) dural substitute between the dura mater and skull before applying the shock wave was investigated in the other 10 rats. Visualizations on shadowgraphy along with pressure measurements were obtained to confirm that the shock wave generator was capable of conveying waves in a limited volume without harmful effects to the target. The attenuation rates of shock waves administered through a 0.7-mm-thick ePTFE dural substitute and a surgical cottonoid were measured to determine which of these materials was suitable for avoiding propagation of the shock wave beyond the target. Conclusions. Using the shock wave generator with the Ho:YAG laser, a localized shock wave (with a maximum overpressure of 50 bar) can be generated from a small device (external diameter 15 mm, weight 20 g). The placement of a 0.7-mm-thick ePTFE dural substitute over the dura mater reduces the overpressure of the shock wave by 96% and eliminates damage to surrounding tissue in the rat brain. These findings indicate possibilities for applying shock waves in various neurosurgical treatments such as cranioplasty, local drug delivery, embolysis, and pain management.