Water Jet Dissection in Neurosurgery: Experimental Results in the Porcine Cadaveric Brain
Water Jet Dissection in Neurosurgery: Experimental Results in the Porcine Cadaveric Brain
复制标题
神经外科中的水射流解剖：猪尸体大脑的实验结果
DOI：
10.1097/00006123-200301000-00020
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发表时间：
2003
期刊：
影响因子：
4.8
通讯作者：
J. Piek
中科院分区：
文献类型：
--
作者：
J. Oertel;M. Gaab;A. Knapp;H. Essig;R. Warzok;J. Piek
目的：水射流解剖作为神经外科手术的一种新工具，目前正在研究中。这台仪器的安全性已得到证实。然而，精确的数据证明高度准确的脑组织解剖与血管保存相结合仍然缺失。方法采用不同喷嘴类型（直径80 ~ 150 μ m，连续直射流或螺旋射流）和不同水射流压力（1 ~ 40 bar）对50头猪尸体脑进行解剖。形态学观察脑各区域及基底动脉的解剖特征。结果在功能可靠性、解剖精度、水射流压力与解剖深度的相关性方面，120-&mgr的效果最好；m螺旋水射流喷嘴。结果表明，压力的增加与剥离深度基本成线性关系。根据所研究的区域不同，解剖深度变化很大，可达三倍（最大的阻力在脑干，其次是半球，然后是小脑）。在大多数情况下，包括基底动脉在内的血管抵抗压力高达15巴，而基底动脉在较高压力下更常被剥离。结论：1)在符合临床情况的条件下，使用水射流可以非常精确、可靠地进行脑实质解剖，并保留血管；2)喷嘴类型和水射流压力必须根据所针对的脑面积和组织仔细选择。本研究为水射流技术在脑内的进一步研究提供了形态学基础。水射流的特性可能使该装置成为神经外科设备的有用补充。
OBJECTIVEWater jet dissection is currently under investigation as a new tool for use in neurosurgical procedures. The safety of this instrument has already been demonstrated. However, precise data demonstrating highly accurate tissue dissection in the brain in combination with vessel preservation are still missing. METHODSIn this study, 50 porcine cadaveric brains were dissected with the use of several nozzle types (80–150 in &mgr;m diameter, coherent straight or helically turned jet) and several levels of water jet pressure (1–40 bars). The dissection characteristics in various brain regions and the basilar artery were evaluated morphologically. RESULTSThe best results regarding reliable function, dissection accuracy, and the correlation of water jet pressure with dissection depth were obtained with the 120-&mgr;m Helix Hydro-Jet nozzle. An almost linear relationship of pressure increase with dissection depth was demonstrated. The dissection depth varied significantly up to threefold, depending on the area investigated (greatest resistance was in the brainstem, followed by hemispheres and then the cerebellum). Vessels including the basilar artery resisted pressure up to 15 bars in most cases, whereas the basilar artery was dissected significantly more often with higher pressure. CONCLUSIONThe results indicate that 1) use of the water jet enables very precise and reliable brain parenchyma dissection with vessel preservation under conditions corresponding to the clinical situation, and 2) the nozzle type and water jet pressure must be selected carefully according to the brain area and tissue targeted. This study provides the morphological basis for further research with the use of the water jet technique in the brain. The water jet’s characteristics may make this device a useful addition to the neurosurgical armamentarium.