Article
Waterjet dissection of low-grade glioma adjacent to eloquent cortex: experience with 21 cases
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Authors
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J. Conrad
- Neurochirurgische Klinik, Universitätsklinikum Mainz
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M.R. Gaab
- Neurochirurgische Klinik, Krankenhaus Nordstadt, Hannover
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J. Oertel
- Neurochirurgische Klinik, Universitätsklinikum Mainz
| Published: | May 20, 2009 |
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Outline
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Objective: In neurosurgery, the number of surgeons having experience with the waterjet device for tissue dissection is increasing. Theoretically, it could allow a reduction of blood loss and surgical trauma as well as enable an increased accuracy of tumor resection within or adjacent to eloquent brain structures.
Methods: Twenty-one low-grade glioma patients (2 pts. WHO grade I, 19 pts. WHO grade II; 10 male, 11 female; mean age 45 yrs, range 12–63 yrs) were operated on with the waterjet between June 1996 and September 2008. Intraoperatively, the general aspects of handling of the device, the extent of its application, and the quality and helpfulness for dissection and tumor aspiration as well as vessel preservation were monitored.
Results: In all cases, the waterjet enabled precise dissection of the tumor from the brain without complications. The mean operation time scored 137 min (range 105–205 min), the mean estimated intradural blood loss 59 cc (range 10–320 cc). Vessels were preserved, and – in 16 of 18 cases intended – radical tumor resection was achieved based on postoperative MRI studies within neurological complications. Tumor aspiration was possible in all but one case. Precise tumor dissection from the adjacent brain parenchyma was possible in all cases – even if the tumor tissue was hardly discernible.
Conclusions: In all, the waterjet can safely be applied in low-grade gliomas – even within or adjacent to eloquent cortex. The device is particularly suitable for precise glioma-parenchyma dissection and might alleviate complete tumor resection and a reduction of blood loss.
