Waterjet Dissection of Gliomas - Experience with 51 Procedures

Abstract

The waterjet dissector device has been shown to allow precise tissue dissection under vessel preservation in liver surgery as well as in first experimental studies in the brain. In clinical neurosurgery, the instrument seems to reduce the operative blood loss and the surgical trauma in poorly demarcated or well vascularized tumors. To evaluate its application characteristics in intrinsic brain tumors, 51 patients harboring gliomas (WHO grades 1 - 4) were operated on with the waterjet dissector. As this device is often compared with ultrasonic aspiration, it was in addition directly compared with the ultrasonic aspirator in twelve cases. Intraoperatively, the waterjet enabled precise tumor separation from the brain under preservation of the tumor-parenchyma border. Tumor aspiration was possible in all but one case. Waterjet pressures of 3 to 17 bars were used, and even very small blood vessels were preserved. Complete tumor mass removal was documented by MRI at three months follow-up in 41 of 43 cases where total resection was intended. Out of 21 patients with tumors located within or close to eloquent cortex, only one patient suffered from permanent worsening of his/her preoperative deficit. In direct comparison with the ultrasonic aspirator, the waterjet significantly reduced the intraoperative blood loss. Tumor debulking was performed more efficiently with ultrasonic aspiration. In all, the waterjet device is particularly suitable for precise glioma-parenchyma dissection and might support complete tumor resection. For glioma aspiration, the ultrasonic aspirator appears to be more efficient. However, when only minimal blood loss is intended, the waterjet device might be favorable even for glioma aspiration. Before the new technique can be considered as an addition to the neurosurgical armamentarium, further evidence is required that the waterjet enables less traumatic surgery than conventional instruments.

Waterjet dissection - glioma - surgical technique - vessel preservation - brain

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