Application of shock waves as treatment modality in the vicinity of the brain and skull.

继发于创伤、手术、感染或先天性畸形的颅骨缺陷有时需要进行颅骨成形术，以重新建立对潜在大脑的严格保护，并改善美容外观。目前的颅骨成形术主要基于“替代颅骨缺损区”的概念，有异物或无异物。然而，由于异物的使用和侵入性的问题，一种新的颅骨成形术应该被开发出来，而不是依赖于异物的使用和微创。在过去的二十年里，冲击波不仅应用于不同部位的结石的非侵入性粉碎，而且应用于髋关节置换中的人工骨水泥的碎裂，以及钙化的肌腱病的疼痛处理，作为一种微创的替代方法引起了人们的关注。近年来，它已被临床应用于治疗长骨延迟愈合和骨不连，诱导成骨。此…More鼓励我们探索冲击波在不使用异物的情况下以更低的侵入性闭合颅骨缺陷的潜力。然而，要在脑部附近应用冲击波，有两个主要问题需要解决：一是缺乏合适的冲击波源来限制冲击波在目标周围的分布；二是缺乏避免冲击波传播到靶外的方法，以确保安全治疗。在我们目前的研究中，我们已经解决了这两个问题，开发了一种紧凑型冲击波发生器和使用Gore-Tex&rreg；硬脑膜替代品的脑保护方法。冲击波的发射是通过一台Ho-Y-Al-石榴石激光诱导的空化冲击波发生器进行的，该发生器是专门为脑和颅骨附近设计的，超压为50bar，频率为3 Hz。我们已经应用了这些技术来观察它们在关闭幼年大鼠颅骨中的骨缺损方面是否有效，并展示了我们的初步结果。目前的结果表明，应用冲击波作为一种不使用异物的颅骨成形术的替代方案是可能的。本研究的结果也将有助于理解神经元与冲击波的相互作用，以及其他应用，如冲击波导向的中枢神经系统药物释放系统。较少

Cranial deficits secondary to trauma, surgery, infection, or congenital malformation sometimes require cranioplasty to re-establish rigid protections for the underlying brain and to improve cosmetic appearance. Current methods for cranioplasty are mainly based on the concept of"replacing the skull defect", either with or without the aid of foreign bodies. However, problems arise from use of foreign matter and invasiveness, a novel method for cranioplasty not reliant on the use of foreign body with minimal invasion should be developed.For last two decades, shock waves have been applied, not only for the non-invasive fragmentation of stones at various locations, but also for the fragmentation of artificial bone cement in the hip arthroplasty, and pain management in calcified tendenopathies, attracting attention as a minimally invasive alternative modality. Recently, it has been clinically applied to the treatment of delayed union and non-union of long bones to induce bone formation. This … More has encouraged us to explore the potential of shock waves for closing skull defects less invasively without using foreign material. However, to apply shock waves in the vicinity of brain, there were two major problems to be solved ; one concerning the lack of a suitable shock wave source that can limit shock wave distribution around the target, and the other is the lack of a method for avoiding shock wave propagation beyond the target to ensure safe treatment. In our present study, we have solved both of those problems by developing a compact shock wave generator and brain protection method using Gore-Tex&rreg ; dura substitute. The shock waves were delivered via a holmium yttrium-aluminum-garnet laser-induced cavitational shock wave generator, which was especially designed for use in the vicinity of brain and skull, with an overpressure of 50 bar, at a rate of 3 Hz. We have applied those techniques to see whether they are effective in the closure of a bone defect in the skull of young rats, and present our preliminary results. Present results show the possibility of applying shock wave as an alternative for cranioplasty without using foreign bodies. The result of present study will also be useful for understanding of interaction between neuron and shock waves, and other application, such as shock wave orientated drug delivery system in central nervous system. Less