Waterjet dissection of the brain: experimental and first clinical results

1998 ◽  
Vol 89 (5) ◽  
pp. 861-864 ◽  
Author(s):  
Jürgen Piek ◽  
Christian Wille ◽  
Rolf Warzok ◽  
Michael-Robert Gaab
Keyword(s):  
Clinical Results ◽  
New Method ◽  
Surrounding Tissue ◽  
Histological Evaluation ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
New Device ◽  
Waterjet Dissection ◽  
The Brain ◽  
Fine Print

✓ Control of bleeding during dissection is a problem that is still not completely resolved in neurosurgical procedures. To overcome this problem in some settings, the authors, in close collaboration with their institution, developed a new device for blunt dissection of brain tumors that is based on a waterjet technique. This report describes their first experimental and clinical experience with this new method. Numerous cutting experiments were performed in porcine cadaver brains. The best results were obtained using pressures from 4 to 6 bars with a 100-jxm tip, which produced very small, precise cuts. Histological evaluation showed no disruption or vacuolization of the surrounding tissue. The authors have used the new device in nine patients (seven with gliomas and two undergoing temporal lobe resections for epilepsy), and no complications have been observed. The waterjet device allowed dissection of the brain tissue while even small exposed vessels were spared injury. The instrument was found to be easy to use. Future investigations will concentrate on adapting this new method to endoscopic surgery and evaluating fluids with low surface tension to avoid foaming and bubbling during open surgery.

General and local hypothermia of the brain in the treatment of intractable epilepsy

1970 ◽  
Vol 33 (3) ◽  
pp. 253-259 ◽  
Author(s):  
K. Šourek ◽  
V. Trávníček
Keyword(s):  
Intractable Epilepsy ◽  
Clinical Results ◽  
Emotional Stability ◽  
Local Temperature ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Changes ◽  
Local Hypothermia ◽  
The Brain ◽  
Fine Print

✓ Twenty-five cases of intractable epilepsy were treated by combined deep general and local extravascular brain hypothermia plus single doses of pentothal (Thiopental) or diazepam. The final local temperature of the brain in 21 patients was below 24°C, the rectal temperatures being 27° to 30°C. There was one death 6 weeks after surgery, and in two patients slight neurological deficits were found at 3 and 6 months postoperatively. In 15 patients in whom at least 1 year had elapsed since surgery, the frequency and intensity of the seizures were reduced by 50% in two, reduced to a single seizure in five, eliminated in four, and unaltered in four. The fair and excellent results included 60% of the group. In three patients improvement in behavior and emotional stability were observed postoperatively; this change was independent of the reduction of the frequency of seizures. Postoperative changes in the electroencephalogram were less frequent than changes in the frequency of seizures and also were completely independent of the clinical results.

Variables affecting the accuracy of stereotactic localization using computerized tomography

1993 ◽  
Vol 79 (5) ◽  
pp. 667-673 ◽  
Author(s):  
Richard D. Bucholz ◽  
Hector W. Ho ◽  
Jason P. Rubin
Keyword(s):  
Computerized Tomography ◽  
Neurosurgical Procedures ◽  
Slice Thickness ◽  
Laptop Computer ◽  
Content Type ◽  
Mean Error ◽  
Critical Areas ◽  
Stereotactic Localization ◽  
The Brain ◽  
Fine Print

✓ Stereotactic localization using computerized tomography (CT) is increasingly employed to guide neurosurgical procedures in crucial areas of the brain such as the brain stem. This technique allows the surgeon to resect a lesion in its entirety while sparing critical areas of the brain. Thus, the parameters used for scanning should be selected for maximum accuracy. While the small pixel size of CT scanners suggests a high degree of precision in localization, there have been few systematic studies of this accuracy. The authors have studied the amount of error in localization created by variables such as CT scan thickness, interscan spacing, size of lesion, and method of computation when using the Brown-Roberts-Wells (BRW) stereotactic system. Over 1000 CT scans were made of a phantom composed of spheres of differing diameter and location. The CT slice thickness was varied from 1.5 to 5.0 mm, and interscan spacing was varied from 0.5 to 3.0 mm. The coordinates of the center of the spheres were calculated independently using the laptop computer supplied with the unit and also by a stereotactic computer which automatically calculates the center of the fiducials. The actual BRW coordinates of the sphere center were obtained using the phantom base and were then compared to the computer-calculated coordinates to determine error in localization. Variables with a significant effect on error included the scan thickness, interscan spacing, and sphere size. The mean error decreased 23% as the scan thickness decreased from 5.0 to 1.5 mm and 45% as the interscan spacing decreased from 3.0 to 0.5 mm. Mean error was greatest for the smallest sphere sizes. The two computational methods did not differ in error. This study suggests that, for critical areas of the brain or for small lesions, a scan thickness of 1.5 mm and interscan spacing of 0.5 mm should be employed.

Waterjet dissection in neurosurgical procedures: clinical results in 35 patients

2002 ◽  
Vol 96 (4) ◽  
pp. 690-696 ◽  
Author(s):  
Juergen Piek ◽  
Joachim Oertel ◽  
Michael Robert Gaab
Keyword(s):  
Blood Loss ◽  
Blood Vessels ◽  
Epilepsy Surgery ◽  
Tumor Resection ◽  
Neurosurgical Procedures ◽  
Normal Brain ◽  
Content Type ◽  
Waterjet Dissection ◽  
Ica Stenosis ◽  
Fine Print

Object. Waterjet dissection represents a new minimally traumatic surgical method for dissection that can be used in various parenchymal organs, in which it allows highly precise parenchymal dissection while preserving blood vessels, resulting in reduced intraoperative blood loss. This study was performed to investigate the clinical application of this new technique in neurosurgical procedures, such as brain tumor resection and epilepsy surgery. Methods. Thirty-four patients with gliomas (Grades II–IV), cerebral metastases, temporal lobe epilepsy, or cerebellar hemangioblastomas, and one patient with internal carotid artery (ICA) stenosis were treated surgically with the aid of the waterjet. Resection was performed using waterjet dissection in combination with conventional neurosurgical procedures. Intraoperatively, the waterjet was easy to handle, and no complications due to the device were observed. Dissection of tissue was possible for all pathological conditions, and pressures between 3 and 45 bars were used. In gliomas, metastases, epilepsy surgery, and hemangioblastoma, the tissue was dissected at pressures between 3 and 17 bars, which preserved blood vessels. Dissection of meningiomas and the ICA stenosis required higher pressures (between 20 and 45 bars); with these pressures, blood vessels were also dissected. Conclusions. These results indicate that the waterjet dissection procedure can be used intraoperatively without complications. This device appears to be particularly suitable for the dissection of highly vascularized gliomas or normal brain tissue, in which tissue dissection with sparing of blood vessels can be achieved. To prove that this is a useful addition to the neurosurgical armamentarium, reduction of blood loss or postoperative brain edema compared with conventional methods should be demonstrated in future studies.

Intraoperative use of real-time ultrasonography in neurosurgery

1982 ◽  
Vol 57 (2) ◽  
pp. 157-163 ◽  
Author(s):  
William F. Chandler ◽  
James E. Knake ◽  
John E. McGillicuddy ◽  
Kevin O. Lillehei ◽  
Terry M. Silver
Keyword(s):  
Arteriovenous Malformation ◽  
Real Time ◽  
Operating Room ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Brain Surface ◽  
The Brain ◽  
Real Time Ultrasonography ◽  
Fine Print

✓ The authors' experience with the intraoperative use of real-time ultrasonography during 21 neurosurgical procedures is reported. These procedures include neoplasm surgery in 18 cases, treatment of an arteriovenous malformation in one case, and ventricular catheter placement for hydrocephalus in two cases. In each of the neoplasm cases, the tumors were imaged just as well through the intact dura as on the brain surface itself. There were no cases in which the pathology could not easily be identified. The use of portable intraoperative ultrasonography in sterile coverings has proven to be extremely useful in localizing small subcortical neoplasms, as well as locating the solid and cystic portions of deep lesions. It has assisted in guiding needles for both biopsy and aspiration. It has also accurately identified and guided Silastic catheters during their placement in the ventricular system in cases of hydrocephalus. The authors have found real-time ultrasonography to be an important new tool in the operating room and will continue to rely on its imaging ability during selected procedures in the future.

Intracerebral infusion of thrombin as a cause of brain edema

1995 ◽  
Vol 83 (6) ◽  
pp. 1045-1050 ◽  
Author(s):  
Kevin R. Lee ◽  
A. Lorris Betz ◽  
Richard F. Keep ◽  
Thomas L. Chenevert ◽  
Seoung Kim ◽  
...  
Keyword(s):  
Brain Edema ◽  
Brain Parenchyma ◽  
Thrombin Inhibitor ◽  
Neurosurgical Procedures ◽  
Edema Formation ◽  
Content Type ◽  
The Right ◽  
The Brain ◽  
Brain Water ◽  
Fine Print

✓ Purified thrombin from an exogenous source is a hemostatic agent commonly used in neurosurgical procedures. The toxicity of thrombin in the brain, however, has not been examined. This study was performed to assess the effect of thrombin on brain parenchyma, using the formation of brain edema as an indicator of injury. Ten µl of test solution was infused stereotactically into the right basal ganglia of rats. The animals were sacrificed 24 hours later, and the extent of brain edema and ion content were measured. Concentrations of human thrombin as low as 1 U/µl resulted in a significant increase in brain water content. Rats receiving 10 U/µl had a mortality rate of 33% compared to no mortality in the groups receiving smaller doses. Thrombin-induced brain edema was inhibited by a specific and potent thrombin inhibitor, hirudin. A medical grade of bovine thrombin commonly used in surgery also caused brain edema when injected at a concentration of 2 U/µl. Edema formation was prevented by another highly specific thrombin inhibitor, Nα-(2-Naphthalenesulfonylglycyl)-4-dl-phenylalaninepiperidide (α-NAPAP). Thrombininduced brain edema was accompanied by increases in brain sodium and chloride contents and a decrease in brain potassium content. Changes in brain ions were inhibited by both hirudin and α-NAPAP, corresponding to the inhibition of brain water accumulation. This study shows that thrombin causes brain edema when infused into the brain at concentrations as low as 1 U/µl, an amount within the range of concentrations used for topical hemostasis in neurosurgery.

Collagen sponge for surface brain protection

1975 ◽  
Vol 43 (5) ◽  
pp. 637-638 ◽  
Author(s):  
Theodore Kurze ◽  
Michael L. J. Apuzzo ◽  
Martin H. Weiss ◽  
James S. Heiden
Keyword(s):  
Collagen Sponge ◽  
Neurosurgical Procedures ◽  
Brain Protection ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors discuss the properties, use, and advantages of collagen sponge as a microneurosurgical adjunct. Experience with the material in over 300 operative cases has demonstrated its value for protecting the surface of the brain during exposure and retraction in neurosurgical procedures.

Lhermitte's phenomenon after high velocity missile injuries of the brain

1971 ◽  
Vol 34 (2) ◽  
pp. 159-163 ◽  
Author(s):  
Robert C. Leaver ◽  
John D. Loeser
Keyword(s):  
High Velocity ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Civilian Trauma ◽  
The Brain ◽  
Fine Print

✓ High velocity wounds of the brain have been associated with the development of Lhermitte's phenomenon in 26 of 56 consecutive cases from Vietnam studied from 1 month to 1 year after injury. No antecedent factors could be identified. Civilian trauma and elective neurosurgical procedures have not, to our knowledge, been reported to cause this sign. Subarachnoid or subdural adhesions are suggested as the cause of Lhermitte's phenomenon in these patients.

A model of focal cortical contusion in gerbils

1982 ◽  
Vol 57 (2) ◽  
pp. 203-209 ◽  
Author(s):  
Alan Crockard ◽  
Joon Kang ◽  
Graeme Ladds
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Surrounding Tissue ◽  
Content Type ◽  
Time Period ◽  
Cortical Contusion ◽  
Capillary Bed ◽  
The Brain ◽  
Fine Print

✓ An experimental model of focal laceration and contusion in gerbils is described. Associated with this injury are systemic changes which are neurogenically mediated and result in an immediate reduction in blood pressure, bradycardia, and generalized reduction in cerebral blood flow. There is generalized edema, as judged by a decreased specific gravity in the brain, probably related to reduced blood flow; superimposed on this, there is an edema gradient which is maximal close to the injury. This, in turn, affects the local capillary bed and prevents any local increase in flow. A separate group studied over a longer time period (6 hours) did not reveal egress of Evans blue into the surrounding tissue and this is in contrast to reports from cold-injury studies.

Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 247-254 ◽  
Author(s):  
Jason Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Lung Carcinoma ◽  
Small Cell Lung Carcinoma ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Content Type ◽  
The Brain ◽  
Fine Print

Object. Lung carcinoma is the leading cause of death from cancer. More than 50% of those with small cell lung cancer develop a brain metastasis. Corticosteroid agents, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, median survival for patients with small cell lung carcinoma metastasis is approximately 4 to 5 months after cranial irradiation. In this study the authors examine the efficacy of gamma knife surgery for treating recurrent small cell lung carcinoma metastases to the brain following tumor growth in patients who have previously undergone radiation therapy, and they evaluate factors affecting survival. Methods. A retrospective review of 27 patients (47 recurrent small cell lung cancer brain metastases) undergoing radiosurgery was performed. Clinical and radiographic data obtained during a 14-year treatment period were collected. Multivariate analysis was utilized to determine significant prognostic factors influencing survival. The overall median survival was 18 months after the diagnosis of brain metastases. In multivariate analysis, factors significantly affecting survival included: 1) tumor volume (p = 0.0042); 2) preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time between initial lung cancer diagnosis and development of brain metastasis (p = 0.0127). Postradiosurgical imaging of the brain metastases revealed that 62% decreased, 19% remained stable, and 19% eventually increased in size. One patient later underwent a craniotomy and tumor resection for a tumor refractory to radiosurgery and radiation therapy. In three patients new brain metastases were demonstrating on follow-up imaging. Conclusions. Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases provided effective local tumor control in the majority of patients. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can extend survival.

Relief of facial pain after combined removal of precentral and postcentral cortex

1971 ◽  
Vol 34 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Richard A. Lende ◽  
Wolff M. Kirsch ◽  
Ralph Druckman
Keyword(s):  
Facial Pain ◽  
The Other ◽  
Precentral Gyrus ◽  
Nerve Section ◽  
Content Type ◽  
Burning Pain ◽  
Cortical Localization ◽  
The Brain ◽  
Fine Print ◽  
Frontal Lobotomy

✓ Cortical removals which included precentral and postcentral facial representations resulted in relief of facial pain in two patients. Because of known failures following only postcentral (SmI) ablations, these operations were designed to eliminate also the cutaneous afferent projection to the precentral gyrus (MsI) and the second somatic sensory area (SmII). In one case burning pain developed after a stroke involving the brain stem and was not improved by total fifth nerve section; prompt relief followed corticectomy and lasted until death from heart disease 20 months later. In the other case persistent steady pain that developed after fifth rhizotomy for trigeminal neuralgia proved refractory to frontal lobotomy; relief after corticectomy was immediate and has lasted 14 months. Cortical localization was established by stimulation under local anesthesia. Each removal extended up to the border of the arm representation and down to the upper border of the insula. Such a resection necessarily included SmII, and in one case responses presumably from SmII were obtained before removal. The suggestions of Biemond (1956) and Poggio and Mountcastle (1960) that SmII might be concerned with pain sensibility may be pertinent in these cases.

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