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Waterjet Dissection of Peripheral Nerves: An Experimental Study of the Sciatic Nerve of Rats

Tschan, Christoph A MD1; Keiner, Doerthe MD1; Müller, Harald D MD2; Schwabe, Kerstin MD3; Gaab, Michael R MD4; Krauss, Joachim K MD3; Sommer, Clemens MD2; Oertel, Joachim MD1

doi: 10.1227/NEU.0b013e3181f9b0c8
Surgical Anatomy and Technique

BACKGROUND: Although waterjet dissection has been well evaluated in intracranial pathologies, little is known of its qualities in peripheral nerve surgery. Theoretically, the precise dissection qualities could support the separation of nerves from adjacent tissues and improve the preservation of nerve integrity in peripheral nerve surgery.

OBJECTIVE: To evaluate the potential of the new waterjet dissector in peripheral nerve surgery.

METHODS: Waterjet dissection with pressures of 20 to 80 bar was applied on the sciatic nerves of 101 rats. The effect of waterjet dissection on the sciatic nerve was evaluated by clinical tests, neurophysiological examinations, and histopathological studies up to 12 weeks after surgery.

RESULTS: With waterjet pressures up to 30 bar, the sciatic nerve was preserved in its integrity in all cases. Functional damaging was observed at pressures of 40 bar and higher. However, all but 1 rat in the 80 bar subgroup showed complete functional regeneration at 12 weeks after surgery. Histopathologically, small water bubbles were observed around the nerves. At 40 bar and higher, the sciatic nerves showed signs of direct nerve injury. However, all these animals showed nerve regeneration after 12 weeks, as demonstrated by histological studies.

CONCLUSION: Sciatic nerves were preserved functionally and morphologically at pressures up to 30 bar. Between 40 and 80 bar, reliable functional and morphological nerve regeneration occurred. Waterjet pressures up to 30 bar might be applied safely under clinical conditions. This technique might be well suited to separate intact peripheral nerves from adjacent tumor or scar tissue. Further studies will have to show the clinical relevance of these dissection qualities.

1Neurochirurgische Klinik und Poliklinik, Universitätsmedizin, Johannes Gutenberg-Universität, Mainz, Germany

2Abteilung für Neuropathologie, Universitätsmedizin, Johannes Gutenberg-Universität, Mainz, Germany

3Neurochirurgische Klinik und Poliklinik, Medizinische Hochschule Hannover, Hannover, Germany

4Neurochirurgische Klinik und Poliklinik, Nordstadtkrankenhaus, Klinikum Region Hannover, Hannover, Germany

Received, November 11, 2009.

Accepted, April 16, 2010.

Reprint requests: Joachim Oertel, MD, Neurochirurgische Klinik und Poliklinik, Universitätsmedizin, Johannes-Gutenberg-Universität, Langenbeckstrasse 1, 55131 Mainz, Germany. E-mail:

Copyright © by the Congress of Neurological Surgeons