Waterjet dissection versus ultrasonic aspiration in epilepsy surgery.
OBJECTIVE
Waterjet dissection is currently under close investigation in neurosurgery. Experimentally, precise brain parenchyma dissection with vessel preservation has been demonstrated. Clinically, the safety of the instrument has already been proved. However, precise data demonstrating that waterjet dissection indeed reduces surgical blood loss are still missing.


METHODS
The authors applied the waterjet device in a prospective randomized study in comparison with the ultrasonic aspirator. Because there is little variability in the procedure, 30 patients with temporal lobe epilepsy receiving a tailored temporal lobe resection between December 1999 and October 2002 were selected for this study. Intraoperative vessel preservation, intraoperative blood loss, surgical complications, and epilepsy outcome were evaluated. All patients were followed at 3-month intervals.


RESULTS
During surgery, both instruments were easy to handle. Only with the waterjet dissector, however, were even small intraparenchymal blood vessels preserved. Intraoperative blood loss was significantly reduced with the waterjet (mean, 70 +/- 46 ml) compared with the ultrasonic aspirator (mean, 121 +/- 48 ml). However, no difference in the necessity for blood transfusion occurred. No difference was observed with respect to operation time (238.6 +/- 37.0 min with the waterjet, 247.5 +/- 41.5 min with the ultrasonic aspirator), surgical complications, and outcome.


CONCLUSIONS
The waterjet dissector enables a significant reduction of intraoperative blood loss in the investigated setting. However, further studies are needed to confirm these results with a larger number of patients. Studies also are needed to prove that the reduction of blood loss is of clinical relevance for the outcome of the patients.
Oertel
Joachim
J
Department of Neurosurgery, Hannover Nordstadt Hospital, Haltenhoffstrasse 41, Hannover, Germany. oertelj@freenet.de
Gaab
Michael Robert
MR
Runge
Uwe
U
Schroeder
Henry Werner Siegfried
HW
Piek
Juergen
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation* / Q000379:methods; D004210:Dissection / Q000295:instrumentation* / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D014464:Ultrasonic Therapy / Q000295:instrumentation* / Q000379:methods; D014463:Ultrasonography; D014867:Water
D014867:Water