Waterjet dissection in the brain: review of the experimental and clinical data with special reference to meningioma surgery

Waterjet dissection enables precise parenchymal dissection under preservation of vessels and reduction of intraoperative blood loss in general surgery. The present study reports our experimental and clinical results with this device in neurosurgery. Our experimental studies in the porcine cadaver brain show that the device allows very accurate, precise, and reliable dissection of the brain. A linear relationship between waterjet pressure and dissection depth was demonstrated. Vessel preservation was observed at pressures below 20 bar. Clinically, precise dissection of brain parenchyma and various tumors was performed without complications. Even in meningiomas, with their very variable firmness, vascularization, and adherence to the surrounding brain, accurate dissection could be achieved. However, while tumor separation from the brain was attained with high accuracy and vessel preservation in all cases, only in softer lesions resection by aspiration under vessel preservation was possible with pressures below 20 bar. In all, the waterjet device enables precise tissue dissection and vessel preservation in various pathologies including meningiomas. It could represent an addition to the neurosurgical armamentarium. Further studies will have to show dissection qualities of this device that are superior to conventional methods.