Endoscopic neurosurgery
Endoscopic neurosurgery
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内窥镜神经外科
DOI：
10.1007/bf01541260
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发表时间：
2005
影响因子：
2.4
通讯作者：
F. Heppner
中科院分区：
文献类型：
--
作者：
L. M. Auer;P. Holzer;P. W. Ascher;F. Heppner
本文描述了一种超声引导、激光辅助和电视控制的内窥镜技术，迄今为止已用于133名患者治疗各种颅内病变。在CT或MRI图像重建并决定放置1厘米或2厘米的钻孔后，使用1 cm 5.0 mHz或7.5 mHz术中超声探头将内窥镜从钻孔引导至目标区域。然后引入具有6 mm的外径的22.5cm长的刚性内窥镜管，其具有内置的抽吸冲洗系统、具有600 Μm石英玻璃纤维的NeosteumYag激光器和用于各种微型仪器的入口。将电视摄像机连接到目镜透镜上，使手术者能够通过电视屏幕控制目标区域的进一步手术步骤，从而保证手术区域的无菌性。该技术已用于77例自发性脑内血肿（叶、壳核、丘脑）、8例外伤性脑内血肿、13例脑室血肿、8例小脑血肿和1例脑干血肿的清除。33%的脑内血肿完全或次全清除，55%的脑内血肿清除率超过50%。（12例脑室，12例囊性脑或小脑肿瘤）进行了手术活检，囊肿排空，切除或移除囊肿壁和/或可能与手术有关的并发症发生率为1.6%，并发症发生率为1.6%，死亡率0%。这种高科技内窥镜技术具有手术创伤小、手术时间短的特点，可推荐作为传统神经外科技术的低风险替代方案。
This paper describes an ultrasound-guided, laser-assisted, and TV-controlled endoscopic technique which has been used so far in 133 patients for a variety of intracranial lesions.Following CT or MRI image reconstruction, and a decision on the placement of a 1 cm or a 2 cm burrhole, a 1 cm 5.0 mHz or 7.5 mHz intraoperative ultrasound probe is used to direct the endoscope from the burrhole to the target area. A 22.5 cm long rigid endoscope tube with an outer diameter of 6 mm with an inbuilt suction irrigation system, Neodymium Yag laser with 600 Μm Quartz glass-fibre and an inlet for various microinstruments is then introduced. The attachment of a TV camera to the ocular lens allows the operator to control further surgical steps in the target area via the TV screen and thus warrants sterility in the operating field.The technique has been used for evacuation of 77 spontaneous intracerebral haematomas (lobar, putaminal, thalamic), 8 traumatic intracerebral haematomas, 13 ventricular haematomas, 8 cerebellar haematomas and 1 brainstem haematoma. Total or subtotal evacuation was achieved in 33% of intracerebral haematomas, removal of more than 50% of the clot in 55%.Twenty-four brain tumours (12 ventricular, 12 cystic cerebral or cerebellar tumours) were operated on for biopsy, evacuation of cyst, resection or removal of the cyst wall and/or laser irradiation of solid tumour or the inner cyst wall of cystic tumours.The complication rate probably related to surgery was 1.6%, morbidity 1.6%, mortality 0%.This high-tec endoscopic technique with its minimal surgical trauma and short operation time can be recommended as a low-risk alternative to conventional neurosurgical techniques.