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

最近，随着更好的纤维内窥镜、更好的照明和更多的仪器的可用性，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普遍。我们已经开发了一种柔性神经内窥镜（Yamadori-type 8，町田Manufacturing Co.，有限公司、东京），它具有明显的高分辨率，并配备了一个双极凝固器和一个工作通道的冲洗。2.1mm神经内窥镜具有10，000像素光纤，并提供2- 50 mm景深，80度视野，可弯曲90/60（上/下）度的可操纵头端，2.6mm的工作通道深度脑室内出血（IVH）对新生儿具有破坏性影响，导致严重的神经发育疾病。我们检查了四个新生儿IVH的神经内窥镜。这些患者在计算机断层扫描上有III级或IV级IVH，并在出生后3至4周接受了内窥镜手术。通过右额钻孔将纤维镜引入脑室系统。我们发现在一个病例中，隔静脉曲张首次被确定为IVH的可能原因。脑积水通过内窥镜下冲洗、第三脑室造口术、脉络丛凝固和适当放置脑室腹腔分流术得到缓解。神经内窥镜具有微创性，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.