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Attachments of a Tip-Angling Device and a Working Channel : Development of the Multipurpose Ultrafine Spinal Fiberscope

尖端倾斜装置和工作通道的附件：多用途超细脊柱纤维镜的开发

基本信息

批准号：
10557137
负责人：
SHIMOJI Koki
金额：
$ 7.74万
依托单位：
NIIGATA UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B).
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 2000
项目状态：
已结题

项目摘要

The methods for the attachments to the ultrafine fiberscope of a tip-angling device and a working channel of multipurpose uses, such as recording of physiological events, drug administrations and surgical interventions, were studied during this fiscal year.Fine flexible fiberscopes make it possible to visualize the entire length of the spinal subarachnoid space. However, further access and interventions to the intended structures in the spinal canal have been impossible because of the difficulty of equipping such a fine fiberscope with a tip-angling device and a working channel. Here, we developed fine flexible fiberscopes(1.47 and 1.50 mm in diameter)equipped with a tip-angling device and a working channel. Epidural and subarachnoid spaces were accessed with these fiberscopes in nine pain patients and one patient who underwent subarachnoid cystectomy. The epidural and subarachnoid spaces were easily approached and clearly visualized in all 10 patients without major complications. The fiberscope also reached the epiarachnoid space in all 6 cases tested. The surface of the cord was more clearly observed by angling the tip. Accurate positioning of the tip to a thoracic spinal root was successful in 4 of 5 cases tested. During manipulation of the epidural space, 4 patients noticed root pain ; this pain disappeared following regional injection of 3 ml of 0.5 % lidocaine through a working channel. In two patients, the spinal cord potential from the epidural space was successfully recorded using an electrode inserted through the working channel during step-by-step withdrawal of the fiberscope. Thus, percutaneous interventions to the spinal structures in the epidural and subarachnoid spaces of the pain patients can be achieved using a fine flexible fiberscope with a tip-angling device and a working channel.

本财年，研究了尖端倾斜装置的超细纤维镜附件和多用途工作通道的方法，例如记录生理事件、药物管理和外科手术。精细柔性纤维镜使整个长度的脊柱蛛网膜下腔可视化成为可能。然而，由于很难为这种细纤维镜配备尖端倾斜装置和工作通道，因此不可能进一步接近和干预椎管内的预期结构。在这里，我们开发了配备尖端倾斜装置和工作通道的精细柔性纤维镜（直径 1.47 和 1.50 毫米）。在九名疼痛患者和一名接受蛛网膜下腔囊肿切除术的患者中，使用这些纤维镜进入硬膜外和蛛网膜下腔。所有 10 名患者的硬膜外腔和蛛网膜下腔均易于接近且清晰可见，且无严重并发症。在所有 6 例测试的病例中，纤维镜均到达蛛网膜外腔。通过调整尖端的角度可以更清楚地观察绳索的表面。在测试的 5 例病例中，有 4 例成功将尖端准确定位到胸椎根部。在硬膜外腔操作过程中，4 名患者出现根部疼痛；通过工作通道局部注射 3 毫升 0.5% 利多卡因后，这种疼痛消失。在两名患者中，在逐步撤回纤维镜期间，使用通过工作通道插入的电极成功记录了硬膜外腔的脊髓电位。因此，可以使用带有尖端倾斜装置和工作通道的精细柔性纤维镜来对疼痛患者的硬膜外腔和蛛网膜下腔中的脊柱结构进行经皮干预。