Endoscopic Approaches to the Spinal Cord
Endoscopic Approaches to the Spinal Cord
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DOI：
10.1007/978-3-211-99370-5_12
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发表时间：
2011-01-01
期刊：
影响因子：
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通讯作者：
Teixeira, Manoel Jacobsen
中科院分区：
文献类型：
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作者：
Fonoff, Erich Talamoni;Contreras Lopez, William Omar;Teixeira, Manoel Jacobsen
微创手术已被用于治疗医学上的各种疾病。这些技术的巨大改进提供了脑室内、经鼻和最近用于治疗不同病症的脑池颅内通路。近年来，内窥镜技术被提出用于椎间盘突出症或脊柱退行性疾病的治疗，并取得了很大进展。然而，视频辅助手术尚未触及脊髓。本文介绍了我们最近的经验，程序接近脊髓本身，以提供诊断组织活检或诱导射频消融治疗慢性疼痛综合征。我们描述了三种不同的方法，建议提供进入整个长度的椎管从颅颈过渡，颈胸管（脊髓和神经根）的腰骶部intraraquidian结构（脊髓圆锥和骶神经根）。我们理想地使用内窥镜辅助颈椎前外侧脊髓切断术和三叉神经核束切断术，避免使用造影剂以及血管损伤和随之而来的不可预测的神经功能缺损。该技术还可以提供微创手术，通过选择性神经根切断术治疗痉挛，辅助腰椎管中的导管放置或囊性脊髓炎和蛛网膜囊肿的粘连清创，使CSF流量正常化。
Minimally invasive procedures have been used to treat various diseases in medicine. Great improvements in these techniques have provided intraventricular, transnasal and more recently cisternal intracranial accesses used to treat different conditions. Endoscopic approaches have been proposed for the treatment of disk herniation or degenerative disease of the spine with great progress in the recent years. However the spinal cord has not yet been reached by video-assisted procedures. This article describes our recent experience in procedures to approach the spinal cord itself in order to provide either diagnosis by tissue biopsies or inducing radiofrequency spinal ablation to treat chronic pain syndromes. We describe three different approaches proposed to provide access to the entire length of the spinal canal from the cranium cervical transition, cervico-thoracic canal (spinal cord and radiculi) to the lumbar-sacral intraraquidian structures (conus medularis and sacral roots). We idealized the use of endoscopy to assist cervical anterolateral cordotomies and trigeminal nucleotractotomies, avoiding the use of contrast medium as well as vascular injuries and consequent unpredictable neurological deficits. This technique can also provide minimally invasive procedures to possibly treat spasticity through selective rhizotomies, assist catheter placements in the lumbar canal or debridation of adherences in cystic syringomyelia and arachnoid cysts, providing normalization of CSF flow.