Comparison of waterjet dissection and ultrasonic aspiration: an in vivo study in the rabbit brain.
OBJECTIVE
The waterjet method of dissection has been shown to enable the precise dissection of the parenchyma vessels while preserving blood in cadaveric pig brains. The waterjet device has also been applied clinically to treat various diseases and disorders without complications. Evidence still remains to be gathered as to how the instrument performs in reducing surgical trauma, intraoperative blood loss, and postsurgical brain edema. In the present study the authors investigate these parameters in a comparison between waterjet dissection and ultrasonic aspiration in the rabbit brain in vivo.


METHODS
Thirty-one rabbits received identical bilateral frontal corticotomies, which were created using the waterjet device or an ultrasonic aspirator. The animals were killed 1, 3, or 7 days, or 6 weeks after surgery and their brains were processed for immunohistological analysis. Blood vessel preservation, intraoperative hemorrhage, postsurgical brain edema, and posttraumatic microglial and astoglial reactions were evaluated. Only in animals subjected to waterjet dissection were preserved vessels observed within the corticotomies. In addition, less intraoperative bleeding occurred in animals in which the waterjet was used. The microglial reaction was significantly reduced by waterjet dissection compared with ultrasonic aspiration; however, no difference in edema formation or astrocytic reactivity was observed.


CONCLUSIONS
These results demonstrate that waterjet dissection appears to be less traumatic than ultrasonic aspiration with respect to intraoperative hemorrhage and postoperative microglial reactivity in the rabbit model. Nevertheless, no difference in edema formation could be demonstrated. It remains to be proven that the observed differences are of clinical relevance.
Oertel
Joachim
J
Department of Neurosurgery, Hannover Nordstadt Hospital, Hannover, Germany. oertelj@freenet.de
Gaab
Michael Robert
MR
Pillich
Dirk-Thomas
DT
Schroeder
Henry W S
HW
Warzok
Rolf
R
Piek
Jürgen
J
D000818:Animals; D001707:Biopsy, Needle / Q000295:instrumentation; D001921:Brain / Q000473:pathology*; D004210:Dissection / Q000295:instrumentation; D004867:Equipment Design; D007150:Immunohistochemistry; D011817:Rabbits; D014465:Ultrasonics