Development of flexible ventriculoscope (Yamadori-type VIII) and its application

最近，随着更好的光纤镜片的出现，改进的照明和更多的仪器，神经内窥镜在神经外科和其他医学领域以及动物实验中变得越来越常见。我们已经开发了一种柔性神经内窥镜(Yamadori-Type 8型，东京真田制造有限公司)，它具有显著的高分辨率，并配备了双极电凝器和用于冲洗的工作通道。2.1 mm的神经内窥镜有10000个像素的光纤，景深2-50 mm，视场80度，尖端可弯曲90/60(上/下)度，工作通道2.6 mm(外鞘)，灵活工作长度23.3 mm。我们用我们的神经内窥镜检查了4例新生儿IVH。这些患者在出生后三到四周接受了内窥镜手术，CT扫描显示IVH为III级或IV级。纤维内窥镜通过右额毛刺孔进入脑室系统。我们发现1例首次被确定为可能的原因的间隔静脉曲张，脑积水通过内窥镜下冲洗、第三脑室造口、脉络丛凝固术和适当的脑室-腹膜分流术得到缓解。神经内窥镜具有侵袭性小的特点，可用于新生儿脑室内病变的诊断和治疗。

Recently with the availability of better fiberseopes, improved lighting and increased instrumentation, neuroendoscopy is becoming more common in neurosurgery and other medical fields as well as experimentally in animals . We have developed a flexible neuroendoscope (Yamadori-type 8, Machida Manufacturing Co., Ltd., Tokyo), which has a conspicuously high resolving power and is equipped with a bipolar coagulator and a working channel for irrigation. The 2.1mm neuroendoscope had 10,000 pixel optical fiber and provided a 2-50mm depth of field, an 80-degree field of view, a steerable tip that can be bent 90/60 (up/down) degrees, a working channel of 2.6mm (outer sheath) and a flexible working length of 23.3mm.Profound intraventricular hemorrhage (IVH) has devasting effects on neonates, leading to significant neurodevelopmental morbidity. We examined four neonates with IVH by our neuroendoscope. The patients had grade III or IV IVH on computed tomography scans and received endoscopic operations three to four weeks after birth. The fiberscope was introduced into the ventricular system through a right frontal burr hole. We found in one case the varices of the septal vein which were identified for the first time as a possible cause of IVH.Hydrocephalus was relieved endoscopically by irrigation, third ventriculostomy, coagulation of choroid plexus, and adequate placement of ventriculoperitoneal shunting was also performed endoscopically. The neuroendoscope may be useful for diagnosis and treatment on intracerebroventricular regions in neonates because of the minimal invasiveness.