Waterjet dissection of the vestibulocochlear nerve: an experimental study.
OBJECTIVE
Waterjet dissection has been shown to protect intracerebral vessels, but no experience exists in applying this modality to the cranial nerves. To evaluate its potential, the authors examined waterjet dissection of the vestibulocochlear nerve in rats.


METHODS
Lateral suboccipital craniectomy and microsurgical preparation of the vestibulocochlear nerve were performed in 42 rats. Water pressures of 2-10 bar were applied, and the effect was microscopically evaluated. Auditory brainstem responses (ABRs) were used to define nerve function compared with preoperative values and the healthy contralateral side. The final anatomical preparation documented the morphological and histological effects of waterjet pressure on the nerve.


RESULTS
In using up to 6 bar, the cochlear nerve was preserved in all cases. Eight bar moderately damaged the nerve surface. A 10-bar jet markedly damaged or even completely dissected the nerve. Time course analysis of the ABR demonstrated complete functional nerve preservation up to 6 bar after 6 weeks in all rats. Waterjet dissection with 8 bar was associated with a 60% recovery of ABR. In the 10-bar group, no recovery was seen.


CONCLUSIONS
Microsurgical dissection of cranial nerves is possible using waterjet dissection while preserving both morphology and function. The aforementioned jet pressures are known to be effective in neurosurgical treatment of tumors. Thus, waterjet dissection may be useful in skull base surgery including dissection of cranial nerves from tumors. Further studies on this subject are encouraged.
Department of Neurosurgery, Hannover Medical School, Hannover Nordstadt Hospital, Hannover, Germany.
Christoph
C
Tschan
Michael Robert
MR
Gaab
Joachim Kurt
JK
Krauss
Joachim
J
Oertel
D000818:Animals; D003056:Cochlear Nerve / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D016057:Evoked Potentials, Auditory, Brain Stem; D008866:Microsurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D011312:Pressure; D051381:Rats; D014725:Vestibular Nerve / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D014867:Water
D014867:Water