Slicing through complexity: a systematic review assessing the efficacy and safety of water-jet dissection in neurosurgical procedures with technical suggestions.

Dissection methods are variable, and surgeons select the appropriate method based on its safety, efficiency and applicability. The water-jet dissection technique is a promising method that has been applied in different surgeries. We try to highlight the possible neurosurgical applications and evaluate the safety and efficacy of this technique. We conducted a comprehensive systematic review search in the following electronic databases: PubMed, Embase, Web of Science, and Cochrane Library from inception to January 2025. A qualitative synthesis was performed to summarize the findings on the efficacy, safety, and technical challenges of water-jet dissection in neurosurgery. A total of 401 patients were included in our review. Nine studies (351 patients) used the conventional water jet dissection technique, and 4 studies (50 patients) used the laser-based technique. Conventional water jet dissection has been employed in 183 cases involving glioma (52.1%), 32 cases involving meningioma (9.1%), 75 cases for other tumors (21.3%), 46 cases in epilepsy surgery (13.1%). Laser-based techniques have been less frequently used, with 10 cases reported for meningioma (12.3%), 25 cases for other tumors (30.8%), and 46 cases for vascular surgeries (56.7%). For conventional water-jet dissection, complications were observed, with vessel injury and wound infection/brain abscess occurring in 10 cases each (2.8%), post-operative edema in 3 cases (0.8%), air embolism in 1 case (0.3%), failed dissection in 13 cases (3.7%), other complications in 10 cases (2.8%), and no reported thermal injury. Only 3 (6%) complications were observed in the pulsed-based water-jet dissection technique. Water-jet dissection is a promising tool that can be used safely in neurosurgical interventions. However, precautions should be taken to minimize its potential risks and ensure optimal patient outcomes. Robust research in the form of randomized clinical trials and prospective case series should be recruited for further evaluation of this tool.