Shock wave-induced brain injury in rat: novel traumatic brain injury animal model.

BACKGROUND: In blast wave injury and high-energy traumatic brain injury, shock waves (SW) play an important role along with cavitation phenomena. However, due to lack of reliable and reproducible technical approaches, extensive study of this type of injury has not yet been reported. The present study aims to develop reliable SW-induced brain injury model by focusing micro-explosion generated SW in the rat brain. METHODS: Adult male rats were exposed to single SW focusing created by detonation of microgram order of silver azide crystals with laser irradiation at a focal point of a truncated ellipsoidal cavity of20 mm minor diameter and the major to minor diameter ratio of 1.41 after craniotomy. The pressure profile was recorded using polyvinylidene fluoride needle hydrophone. Animals were divided into three groups according to the given overpressure: Group I: Control, Group II: 12.5 +/- 2.5 MPa (high pressure), and Group III: 1.0 +/- 0.2 MPa (low pressure). Histological changes were evaluated over time by hematoxylin-eosin staining. FINDINGS: Group II SW injuries resulted in contusional hemorrhage in reproducible manner. Group III exposure resulted in spindle-shaped changes of neurons and elongation of nucleus without marked neuronal injury. CONCLUSIONS: The use of SW loading by micro-explosion is useful to provide a reliable and reproducible SW-induced brain injury model in rats.

Pulsed holmium:yttrium-aluminum-garnet laser-induced liquid jet as a novel dissection device in neuroendoscopic surgery.

OBJECT: A pressure-driven continuous jet of water has been reported to be a feasible tool for neuroendoscopic dissection owing to its superiority at selective tissue dissection in the absence of thermal effects. With respect to a safe, accurate dissection, however, continuous water flow may not be suitable for intraventricular use. The authors performed experiments aimed at solving problems associated with continuous flow by using a pulsed holmium:yttrium-aluminum-garnet (Ho:YAG) laser-induced liquid jet (LILJ). They present this candidate neuroendoscopic LILJ dissection system, having examined its mechanical characteristics and evaluated its controllability both in a tissue phantom and in a rabbit cadaveric ventricle wall. METHODS: The LILJ generator was incorporated into the tip of a No. 4 French catheter so that the LILJ could be delivered via a neuroendoscope. Briefly, the LILJ was generated by irradiating an internally supplied column of physiological saline with a pulsed Ho:YAG laser (pulse duration time 350 microsec; laser energy 250-700 mJ/pulse) within a No. 4 French catheter (internal diameter 1 mm) and ejecting it from a metal nozzle (internal diameter 100 microm). The Ho:YAG laser energy pulses were conveyed by an optical fiber (core diameter 400 microm) at 3 Hz, whereas physiological saline (4 degrees C) was supplied at a rate of 40 ml/hour. The mechanical characteristics of the pulsed LILJ were investigated using high-speed photography and pressure measurements; thermal effects and controllability were analyzed using an artificial tissue model (10% gelatin of 1 mm thickness). Finally, the ventricle wall of a rabbit cadaver was dissected using the LILJ. Jet pressure increased in accordance with laser energy from 0.1 to 2 bar; this translated into a penetration depth of 0.08 to 0.9 mm per shot in the ventricle wall of the rabbit cadaver. The gelatin phantom could be cut into the desired shape without significant thermal effects and in the intended manner, with a good surgical view. CONCLUSIONS: The present results show that the pulsed LILJ has the potential to become a safe and reliable dissecting method for endoscopic procedures.

Experimental application of pulsed Ho:YAG laser-induced liquid jet as a novel rigid neuroendoscopic dissection device.

BACKGROUND AND OBJECTIVES: Although water jet technology has been considered as a feasible neuroendoscopic dissection methodology because of its ability to perform selective tissue dissection without thermal damage, problems associated with continuous use of water and the ensuing fountain-effect-with catapulting of the tissue-could make water jets unsuitable for endoscopic use, in terms of safety and ease of handling. Therefore, the authors experimented with minimization of water usage during the application of a pulsed holmium:yttrium-aluminum-garnet (Ho:YAG) laser-induced liquid jet (LILJ), while assuring the dissection quality and the controllability of a conventional water jet dissection device. We have developed the LILJ generator for use as a rigid neuroendoscope, discerned its mechanical behavior, and evaluated its dissection ability using the cadaveric rabbit ventricular wall. STUDY DESIGN/MATERIALS AND METHODS: The LILJ generator is incorporated into the tip of a stainless steel tube (length: 22 cm; internal diameter: 1.0 mm; external diameter: 1.4 mm), so that the device can be inserted into a commercial, rigid neuroendoscope. Briefly, the LILJ is generated by irradiating an internally supplied water column within the stainless steel tube using the pulsed Ho:YAG laser (wave length: 2.1 microm, pulse duration time: 350 microseconds) and is then ejected through the metal nozzle (internal diameter: 100 microm). The Ho:YAG laser pulse energy is conveyed through optical quartz fiber (core diameter: 400 microm), while cold water (5 degrees C) is internally supplied at a rate of 40 ml/hour. The relationship between laser energy (range: 40-433 mJ/pulse), standoff distance (defined as the distance between the tip of the optical fiber and the nozzle end; range: 10-30 mm), and the velocity, shape, pressure, and average volume of the ejected jet were analyzed by means of high-speed camera, PVDF needle hydrophone, and digital scale. The quality of the dissection plane, the preservation of blood vessels, and the penetration depth were evaluated using five fresh cadaveric rabbit ventricular walls, under neuroendoscopic vision. RESULTS: Jet velocity (7.0-19.6 m/second) and pressure (0.07-0.28 MPa) could be controlled by varying the laser energy, which determined the penetration depth in the cadaveric rabbit ventricular wall (0.07-1.30 mm/shot). The latter could be cut into desirable shapes-without thermal effects-under clear neuroendoscopic vision. The average volume of a single ejected jet could be confined to 0.42-1.52 microl/shot, and there was no accompanying generation of shock waves. Histological specimens revealed a sharp dissection plane and demonstrated that blood vessels of diameter over 100 microm could be preserved, without thermal damage. CONCLUSIONS: The present pulsed LILJ system holds promise as a safe and reliable dissection device for deployment in a rigid neuroendoscope.