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

本财政年度研究了用于记录生理事件、给药和手术干预等多用途的超细纤维镜的附着方法和工作通道。精细的柔性纤维镜使脊髓蛛网膜下腔的整个长度可视化成为可能。然而，进一步进入和干预椎管中的预期结构是不可能的，因为这样一个精细的纤维镜很难装备一个倾斜的装置和一个工作通道。在这里，我们开发了精细的柔性纤维镜（直径1.47和1.50 mm），配备了一个倾斜装置和一个工作通道。在9例疼痛患者和1例接受蛛网膜下腔膀胱切除术的患者中，使用纤维镜检查硬膜外和蛛网膜下腔间隙。硬膜外腔和蛛网膜下腔均易于接近和清晰可见，无重大并发症。6例患者纤维镜均可到达蛛网膜外腔。通过倾斜尖端，可以更清楚地观察到脐带的表面。在测试的5个病例中，有4个成功地将尖端精确定位到胸椎根。在硬膜外间隙操作过程中，4例患者出现根痛；经工作通道局部注射3ml 0.5%利多卡因后疼痛消失。在两例患者中，在逐步取出纤维镜的过程中，通过工作通道插入电极，成功地记录了硬膜外间隙的脊髓电位。因此，在疼痛患者的硬膜外和蛛网膜下腔的脊髓结构的经皮介入可以实现使用一个精细的柔性纤维镜的尖端倾斜装置和工作通道。

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.