Waterjet dissection of the brain: experimental and first clinical results

Technical note

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✓ Control of bleeding during dissection is a problem that is still not completely resolved in neurosurgical procedures. To overcome this problem in some settings, the authors, in close collaboration with their institution, developed a new device for blunt dissection of brain tumors that is based on a waterjet technique. This report describes their first experimental and clinical experience with this new method. Numerous cutting experiments were performed in porcine cadaver brains. The best results were obtained using pressures from 4 to 6 bars with a 100-jxm tip, which produced very small, precise cuts. Histological evaluation showed no disruption or vacuolization of the surrounding tissue.

The authors have used the new device in nine patients (seven with gliomas and two undergoing temporal lobe resections for epilepsy), and no complications have been observed. The waterjet device allowed dissection of the brain tissue while even small exposed vessels were spared injury. The instrument was found to be easy to use. Future investigations will concentrate on adapting this new method to endoscopic surgery and evaluating fluids with low surface tension to avoid foaming and bubbling during open surgery.

Article Information

Address reprint requests to: Jürgen Piek, M.D., Klinik und Poliklinik für Neurochirurgie, Ernst-Moritz-Arndt Universität, Sauerbruchstraße 8, D-17487 Greifswald, Germany. email: neurosur@rz.uni-greifswald.de.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph showing cutting effects of the waterjet in porcine cadaver brains for different pressures and nozzle diameters (each point represents a single cut; the curve links the mean values for five cuts at a given pressure).

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    Photomicrograph of a histological sample showing multiple cuts produced at 4 bars with a 100-µm tip. Note precise, uniform cutting depth and preservation of a small pial vessel in cut no. 2 (arrow).

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    Photomicrographs of various histological samples demonstrating sharp dissection of the brain without damage to the surrounding tissue. Original magnification × 5 (left); × 100 (right).

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    Intraoperative photograph demonstrating sparing of even small vessels by the new device.

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