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损有时需要颅骨成形术来重建对底层大脑的刚性保护并改善外观。目前的颅骨成形术主要是基于“置换颅骨缺损”的概念，无论是否有异物的帮助。然而，由于异物的使用和侵入性的问题，需要开发一种新的方法来进行颅骨成形术，而不依赖于使用异物，具有最小的侵入性。在过去的二十年中，冲击波已经被应用于各种位置的结石的非侵入性破碎，而且还用于髋关节成形术中人工骨水泥的破碎，以及钙化肌腱病的疼痛管理，作为一种微创的替代方式引起了人们的注意。近年来临床上用于治疗长骨延迟愈合和骨不连，诱导骨形成。这 关于我们 鼓励我们探索冲击波在不使用异物的情况下以较少侵入性闭合颅骨缺损的潜力。然而，为了在脑部附近施加冲击波，存在两个需要解决的主要问题;一个是关于缺乏可以限制目标周围的冲击波分布的合适的冲击波源，另一个是缺乏用于避免冲击波传播超出目标以确保安全治疗的方法。在我们目前的研究中，我们已经解决了这两个问题，通过开发一个紧凑的冲击波发生器和脑保护方法使用戈尔特克斯硬脑膜替代品。冲击波通过钬钇铝石榴石激光诱导空化冲击波发生器传递，该发生器特别设计用于脑和颅骨附近，超压为50 bar，速率为3 Hz。我们已经应用这些技术，看看他们是否是有效的，在年轻的大鼠颅骨骨缺损的关闭，并提出我们的初步结果。目前的结果表明，应用冲击波作为替代颅骨成形术，而不使用异物的可能性。本研究的结果也将有助于理解神经元与冲击波之间的相互作用，以及其他应用，如冲击波导向的药物输送系统在中枢神经系统。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