Use of Actuator-Driven Pulsed Water Jet in Brain and Spinal Cord Cavernous Malformations Resection.
BACKGROUND
A piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. It can potentially resect intra-axial lesions while preserving neurological function.


OBJECTIVE
To report our first experience of applying an ADPJ system to brain and spinal cord cavernous malformations.


METHODS
Four patients (2 women and 2 men, mean age 44.5 years) with brain (n = 3) and spinal cord (n = 1) cavernous malformations were enrolled in the study. All surgeries were performed with the aid of the ADPJ system. Postoperative neurological function and radiological findings were evaluated.


RESULTS
The ADPJ system was useful in dissecting boundaries between the lesion and surrounding brain/spinal cord tissues. The pulsed water jet provided a clear surgical view and helped surgeons follow the margins. Water jet dissection peeled off the brain and spinal cord tissues from the lesion wall. Surrounding gliotic tissue was preserved. As a consequence, the cavernous malformations were successfully removed. Postoperative magnetic resonance imaging confirmed total removal of lesions in all cases. Preoperative neurological symptoms completely resolved in 2 patients. The others experienced partial recovery. No patients developed new postoperative neurological deficits; facial palsy temporarily worsened in 1 patient who underwent a suprafacial colliculus approach for the brainstem lesion.


CONCLUSIONS
The ADPJ provided a clear surgical field and enabled surgeons to dissect boundaries between lesions and surrounding brain and spinal cord gliotic tissue. The ADPJ system is a feasible option for cavernous malformation surgery, enabling successful tumor removal and preservation of neurological function.
Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Japan.
Toshiki
T
Endo
Yoko
Y
Takahashi
Atsuhiro
A
Nakagawa
Kuniyasu
K
Niizuma
Miki
M
Fujimura
Teiji
T
Tominaga
D000328:Adult; D001921:Brain / Q000002:abnormalities / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D002550:Cerebral Veins / Q000473:pathology / Q000601:surgery; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D013116:Spinal Cord / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome