Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery

Background In insular glioma surgery, accurately localizing the lateral surface of putamen remains challenging. This study aimed to explore a water dissection⁃based technique for sculpting the lateral surface of putamen during insular glioma surgery. Methods and Results Total 17 patients with insula...

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Main Authors: WU Dong⁃dong, SHU Xu⁃jun, ZHAO Kai, CONG Xiao⁃jun, ZHOU Xing⁃yu, XIA Ying, SUN Guo⁃chen
Format: Article
Language:English
Published: Tianjin Huanhu Hospital 2025-03-01
Series:Chinese Journal of Contemporary Neurology and Neurosurgery
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Online Access:http://www.cjcnn.org/index.php/cjcnn/article/view/2999
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author WU Dong⁃dong
SHU Xu⁃jun
ZHAO Kai
CONG Xiao⁃jun
ZHOU Xing⁃yu
XIA Ying
SUN Guo⁃chen
author_facet WU Dong⁃dong
SHU Xu⁃jun
ZHAO Kai
CONG Xiao⁃jun
ZHOU Xing⁃yu
XIA Ying
SUN Guo⁃chen
author_sort WU Dong⁃dong
collection DOAJ
description Background In insular glioma surgery, accurately localizing the lateral surface of putamen remains challenging. This study aimed to explore a water dissection⁃based technique for sculpting the lateral surface of putamen during insular glioma surgery. Methods and Results Total 17 patients with insular glioma hospitalized in the Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital from January 2020 to December 2024, all of the tumor were not involved in the putamen and the tumor was resected by trans⁃frontal isthmus approach. A self⁃ constructed low⁃pressure water flow system was used to separate the Sanai⁃Berger zoneⅠ(2 cases), Ⅰ + Ⅳ(6 cases), andⅠ + Ⅳ + Ⅲ + Ⅱ(9 cases). The bottom of the tumor was easily separated from the lateral surface of the putamen, and the lenticulostriate artery exposed on the lateral surface of the putamen was not damaged during the operation, and the separation process was smooth. Within 24 h after surgery, MRI showed the separation of the lateral surface of the putamen from the tumor was appropriate, the lateral surface of the putamen was sharp and regular, and the tumors were nearly completely removed, and the separation effect was good. No complications related to water dissection occurred. At 3 months follow⁃up, aphasia quotient (AQ) was > 93.80, the operative related side muscle strength was > 4+, and Karnofsky Performance Status (KPS) median score was 90 (90, 100). Conclusions For low⁃grade insular gliomas without putamen involvement characterized by "Jing⁃Wei River sign", water dissection effectively delineates the tumor⁃putamen surface, reduces surgical difficulty, shortens the learning curve, and enhances safety and efficiency.
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spelling doaj-art-bccadf52c99a4b2094c2ac297b0e4d732025-08-20T03:18:52ZengTianjin Huanhu HospitalChinese Journal of Contemporary Neurology and Neurosurgery1672-67312025-03-0125319319810.3969/j.issn.1672⁃6731.2025.03.005Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgeryWU Dong⁃dong0SHU Xu⁃jun1ZHAO Kai2CONG Xiao⁃jun3ZHOU Xing⁃yu4XIA Ying5SUN Guo⁃chen6Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, ChinaDepartment of Neurosurgery, General Hospital of Eastern Theater Command, Nanjing 210002, Jiangsu, China Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, ChinaDepartment of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, ChinaDepartment of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, ChinaDepartment of Neurosurgery, Xiangya School of Medicine, Haikou Affiliated Hospital of Central South University, Haikou 570208, Hainan, China Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, ChinaBackground In insular glioma surgery, accurately localizing the lateral surface of putamen remains challenging. This study aimed to explore a water dissection⁃based technique for sculpting the lateral surface of putamen during insular glioma surgery. Methods and Results Total 17 patients with insular glioma hospitalized in the Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital from January 2020 to December 2024, all of the tumor were not involved in the putamen and the tumor was resected by trans⁃frontal isthmus approach. A self⁃ constructed low⁃pressure water flow system was used to separate the Sanai⁃Berger zoneⅠ(2 cases), Ⅰ + Ⅳ(6 cases), andⅠ + Ⅳ + Ⅲ + Ⅱ(9 cases). The bottom of the tumor was easily separated from the lateral surface of the putamen, and the lenticulostriate artery exposed on the lateral surface of the putamen was not damaged during the operation, and the separation process was smooth. Within 24 h after surgery, MRI showed the separation of the lateral surface of the putamen from the tumor was appropriate, the lateral surface of the putamen was sharp and regular, and the tumors were nearly completely removed, and the separation effect was good. No complications related to water dissection occurred. At 3 months follow⁃up, aphasia quotient (AQ) was > 93.80, the operative related side muscle strength was > 4+, and Karnofsky Performance Status (KPS) median score was 90 (90, 100). Conclusions For low⁃grade insular gliomas without putamen involvement characterized by "Jing⁃Wei River sign", water dissection effectively delineates the tumor⁃putamen surface, reduces surgical difficulty, shortens the learning curve, and enhances safety and efficiency.http://www.cjcnn.org/index.php/cjcnn/article/view/2999gliomawater dissection (not in mesh)neurosurgical procedures
spellingShingle WU Dong⁃dong
SHU Xu⁃jun
ZHAO Kai
CONG Xiao⁃jun
ZHOU Xing⁃yu
XIA Ying
SUN Guo⁃chen
Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery
Chinese Journal of Contemporary Neurology and Neurosurgery
glioma
water dissection (not in mesh)
neurosurgical procedures
title Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery
title_full Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery
title_fullStr Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery
title_full_unstemmed Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery
title_short Application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery
title_sort application of intelligent water dissection technology in sculpting the lateral surface of putamen during insular glioma surgery
topic glioma
water dissection (not in mesh)
neurosurgical procedures
url http://www.cjcnn.org/index.php/cjcnn/article/view/2999
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