Waterjet dissection of the brain: experimental and first clinical results

Control of bleeding during dissection is a problem that is still not comple tely resolved in neurosurgical procedures. To overcome this problem in some settings, the authors, in close collaboration with their institution, deve loped a new device for blunt dissection of brain tumors that is based on a watejet technique. This report describes their first experimental and clini cal experience with this new method. Numerous cutting experiments were perf ormed in porcine cadaver brains. The best results were obtained using press ures from 4 to 6 bars with a 100-mu m tip, which produced very small, preci se cuts. Histological evaluation showed no disruption or vacuolization of t he surrounding tissue. The authors have used the new device in nine patients (seven with gliomas a nd two undergoing temporal lobe resections for epilepsy), and no complicati ons 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 ada pting this new method to endoscopic surgery and evaluating fluids with low surface tension to avoid foaming and bubbling during open surgery.