Water dissection technique of Toth for opening neurosurgical cleavage planes

Background: The low-pressure water dissection technique of Toth, first reported in 1987, is a method to cautiously open neurosurgical cleavage planes such as the sylvian fissure or the interhemispheric space, and the interfaces between extraparenchymal masses and the adjacent brain. The aim of this technical report is to present our long-term experience with this simple and elegant asset of microneurosurgery and to promote its widespread use. Method: Water is injected under microscopic control by a handheld syringe with a blunt needle or by an irrigating balloon applying repeated injections of physiological saline into the cleavage plane to open it. Findings and Conclusion: The water dissection technique of Toth has been extensively used in Budapest and Helsinki in thousands of microsurgical cases, in removal of meningiomas and to open sylvian and interhemispheric fissure. In our experience, there have been no noticeable complications, and we recommend this technique for widespread use. It is a very inexpensive, simple, and effective method not requiring any expensive or complicated devices. (c) 2006 Elsevier Inc. All rights reserved.