DEVELOPMENTS OF FINE FIBERSCOPES AND IMAGE-ENHANCEMENT SYSTEM FOR EPIDURAL AND SUBARACHNOID SPACES

研制了一套具有精细柔性纤维内窥镜的内窥镜系统，并进行了硬膜外和蛛网膜下腔的临床应用。1.内窥镜系统：内窥镜采用0.5 mm、0.9 mm或1.4 mm直径的挠性纤维内窥镜，内窥镜中含有1000-3000个8微米玻璃纤维元件。内窥镜的图像由电视摄像机拍摄，并在内窥镜检查期间进行监视。这些图像也被用录像带记录下来。2.硬膜外及蛛网膜下腔内窥镜检查：将纤维内窥镜置入蛛网膜下腔或硬膜外间隙，置入L 1~2或L 3~4水平的14G图比针。硬膜外间隙视野模糊，但有时可观察到清晰的韧带和硬脑膜图像。若要获得清晰的硬膜外间隙图像，可能需要改进聚焦装置或在纤维内窥镜顶端留出空间。蛛网膜下腔的视野大致清晰。脊髓、背根和脊髓上的血管清晰可见。脊髓腹面难以观察，枕大池图像清晰可见。1.4 mm PHI纤维内窥镜获得的图像比其他更精细的纤维内窥镜获得的图像更清晰。根据我们目前的内窥镜检查经验，该内窥镜系统可应用于硬膜外和蛛网膜下腔的诊断。随着向纤维内窥镜注入药物的通道的增加，该系统还将用于治疗椎管内的一些疾病。

An endoscope system with fine flexible fiberscopes was developed and clinical applications of the system for observation of epidural and subarachnoid spaces were carried out. l.Endoscope system: The endoscope equipped with 0.5, 0.9 or 1.4mmphi flexible fiberscope which contains 1000-3000 elements of 8mu m glass fiber in an image guide were manufactured. Images of the endoscope were taken by an TV camera and monitored during endoscopy. The images were also recorded with videotape. 2.Endoscopy of epidural and subarachnoid spaces: The fiberscopes were inserted into subarachnoid or epidural spaces through a 14G Touby needle placed at the level of L_<1-2> or L_<3-4>. View in epidural space was obscure, but sometimes the clear images of ligament and dura were observed. The improvement of focusing device or making a space at the tip of the fiberscope may be required to obtain the clear images of epidural spaces. The view of the subarachnoid space was generally clear. Spinal cord, dosal roots and vessels on the spinal cord were distinctly observed. Ventral surface of spinal cord were difficult to observe, but images of cisterna magna could be clearly observed. The image taken by 1.4mm phi fiberscope was more distinct than those taken by the other finer fiberscopes. From the experience of our endoscopy so far, it is suggested that this endoscope system could be applicable to the diagnosis in epidural and subarachnoid spaces. With addition of channels for injection of drugs to the fiberscopes, the system will also be used to treat some disorders in the spinal canal.