title: Resection of C6 gliomas in rats with the aid of the waterjet technique.
abstract: OBJECTIVE
  While clinically the safety and efficacy of waterjet resection of brain tumors have been shown, evidence that waterjet dissection improves tumor resection radicality in comparison with conventional techniques is still missing. In the present study, resection radicality and tumor-free long-term survival of both techniques were evaluated in a C6-glioma model.
  
  
  METHODS
  Fifty-thousand C6-glioma cells were stereotactically transplanted in the left frontal lobe of 100 male Sprague-Dawley rats. After MRI-scanning for evaluation of tumor extension, microsurgical tumor resection was performed with conventional techniques (n=50) or with the waterjet dissector at pressures of 6bar (n=50). Twenty-five animals of each group were sacrificed after surgery for histological analysis. For analysis of survival after tumor resection, twenty-five animals of each group were followed-up to analyze tumor-free survival using the Kaplan Meier method.
  
  
  RESULTS
  In the waterjet group, the resection cavity was free of C6-tumor cells in 10/25 (40%) rats showing a trend (p=0.3) towards better resection radicality compared to the rats that were treated conventionally (7/10; 28%). R1-resection with up to 250C6 cells/object slice was found in 14/25 (56%) rats after waterjet dissection compared to 6/25 (24%) rats treated conventionally showing significance (p<0.01). Probability of survival was 38% after 2 weeks and 20% after 6 months in the waterjet group compared to 30% and 16% respectively in the conventional group. Diffuse tumor cell spreading with possible influence on survival was shown in 47/50 rats.
  
  
  CONCLUSIONS
  In this experimental model, waterjet tumor resection did reveal significantly better resection radicality compared to the conventional technique. Although a direct transfer of these results to human glioma surgery is prohibited, the waterjet technique might contribute to the best possible resection radicality in human gliomas. Nevertheless, tumor cell spreading remains a major problem. Further studies have to address that the surgical results - in deed - improve the postoperative outcome.
authors.affiliation: Department of Neurosurgery, University Medical Center Saarland, Homburg-Saar, Germany.
authors.forename: Doerthe
authors.initials: D
authors.lastname: Keiner
authors.affiliation: Institute of Neurosurgical Pathophysiology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Heimann
authors.affiliation: Institute of Neuroradiology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kronfeld
authors.affiliation: Devision of Neuropathology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Sommer
authors.affiliation: Institute of Neuroradiology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany.
authors.forename: Wibke
authors.initials: W
authors.lastname: Mueller-Forell
authors.affiliation: Institute of Neurosurgical Pathophysiology, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kempski
authors.affiliation: Department of Neurosurgery, University Medical Center Saarland, Homburg-Saar, Germany. Electronic address: oertelj@freenet.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Oertel
mesh_terms: D000818:Animals; D001932:Brain Neoplasms / Q000601:surgery*; D004195:Disease Models, Animal; D005910:Glioma / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D051381:Rats; D017207:Rats, Sprague-Dawley
keywords: Brain dissection; C6 gliomas; Surgical technique; Tumor resection; Waterjet dissection device