额外侧锁孔入路的显微与神经内镜解剖

目的对比研究前颅底的显微解剖与神经内镜解剖，为额外侧锁孔手术入路处理前颅底、鞍区病变提供解剖基础。方法经额外侧锁孔手术入路对15具成人尸头进行显微解剖和神经内镜下解剖，比较两种解剖所暴露的范围。结果显微解剖在嗅沟、鞍区和外侧裂存在一定范围的视野盲区；内镜有充足的照明，可将手术视野放大，无视野盲区，清楚地显示周围的解剖结构，而且看得更远。但内镜的图像为二维图像，缺乏景深。神经内镜辅助显微手术可以互补各自不足。结论额外侧锁孔入路在神经内镜的辅助下显微手术切除前颅底和鞍区的病变安全、微创。     

Cyst fenestration and Ommaya reservoir placement in endoscopic transcortical transventricular approach for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly

The efficacy of the endoscopic transcortical transventricular approach (ETTA) for craniopharyngioma in the third ventricle with hydrocephalus has been reported focusing on its reduced invasiveness. On the other hand, suprasellar craniopharyngioma without ventriculomegaly is generally surgically managed by craniotomy or the endoscopic endonasal approach (EEA). Here, we report an elderly patient who received cyst fenestration and Ommaya reservoir placement in ETTA for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly. The ETTA as a less invasive procedure is feasible in patients not only with intraventricular craniopharyngioma but also with suprasellar craniopharyngioma without hydrocephalus provided a navigational system is applied and the surgeon has ample experience with transcranial endoscopic procedures.     

神经内镜下外伤性脑脊液鼻漏修补的临床研究

目的：探讨外伤性脑脊液鼻漏经鼻神经内镜下修补的手术要点及疗效。方法回顾性分析2010年12月至2013年12月山东大学齐鲁医院神经外科应用神经内镜经鼻入路治疗外伤性脑脊液鼻漏22例的临床资料,并就诊断、漏口定位、材料选择、修补方式及疗效等进行讨论。结果21例一次性手术修补成功,随访8～24个月无复发;1例并发脑积水、颅内感染,自动出院,定为失败病例。结论经鼻神经内镜修补外伤性脑脊液鼻漏,手术创伤小,治愈率高,可作为前颅底外伤性脑脊液鼻漏手术修补的首选方法。     

神经内镜手术治疗脑积水和蛛网膜囊肿82例临床观察

目的探讨神经内镜手术治疗脑积水和颅内蛛网膜囊肿的效果．方法采用神经内镜行三脑室底脚间池造瘘、中脑导水管扩张以及囊肿脑室或脑池造瘘手术治疗脑积水和蛛网膜囊肿患者82例．结果术后显效55例（67％），好转21例（25．6％），无效6例（7．4％），总有效率92．6％．结论神经内镜治疗脑积水和蛛网膜囊肿，手术操作简单，疗效可靠，并发症少．     

Endoscopic endonasal resection of symptomatic Rathke cleft cysts

We aimed to retrospectively evaluate the transsphenoidal endoscopic endonasal approach (EEA) for the resection of symptomatic Rathke’s cleft cysts (RCC) in 23 patients (11 male, 12 female, average age 43 years). The patients were followed-up for between 3 months and 36 months. Headache was the primary pre-operative symptom (15/23, 65%) and all patients with headache improved after surgery. Seven patients with initial visual symptoms (9/23, 39%) also improved after treatment. Three of the six patients with pre-operative pituitary dysfunction (6/23, 26%) showed post-operative improvement. There was no permanent pituitary dysfunction. One patient developed temporary diabetes insipidus and two patients had a post-operative infection. Three patients had post-operative cerebrospinal fluid leaks, two of which were repaired using the EEA and the other using a lumbar drain. Two patients had recurrent cysts and both patients refused reoperation. We concluded that the EEA is safe and effective in the treatment of symptomatic RCC. Fenestration and aspiration of the cysts with partial excision of the cyst wall is usually sufficient.     

神经内镜下辅以导航单鼻孔经蝶窦垂体腺瘤切除术25例临床观察

目的 探讨神经内镜下单鼻孔经蝶窦垂体腺瘤切除术的疗效。方法 对25例内镜辅助下单鼻孔经蝶窦入路切除垂体腺瘤的患者的临床资料及术后视力视野、内分泌学及影像学随访结果等资料行回顾性分析。结果 肿瘤全切18例,次全切4例,部分切除3例。术后视力或/和内分泌改善者20例；4例肢端肥大口唇肥厚者面容及手脚均有不同程度缩小。术后脑脊液漏3例,电解质紊乱2例,尿量增多5例,无感染病例。结论 单纯内镜下单鼻孔经蝶切除垂体瘤手术安全、有效、微创,必要时辅以导航技术增加手术安全有效性。随着内镜器械的更新,其操作更加便捷灵活,内镜经鼻蝶切除垂体瘤必将得到更广泛应用。     

Robust registration procedures for endoscopic imaging

This paper presents a robust algorithm for calibration and system registration of endoscopic imaging devices. The system registration allows us to map accurately each point in the world coordinate system into the endoscope image and vice versa to obtain the world line of sight for each image pixel. The key point of our system is a robust linear algorithm based on singular value decomposition (SVD) for estimating simultaneously two unknown coordinate transformations. We show that our algorithm is superior in terms of robustness and computing efficiency to iterative procedures based on Levenberg-Marquardt optimization or on quaternion approaches. The algorithm does not require the calibration pattern to be tracked. Experimental results and simulations verify the robustness and usefulness of our approach. They give an accuracy of less than 0.7 mm and a success rate >99%. We apply the calibrated endoscope to the neurosurgical relevant case of red out, where in spite of the complete loss of vision the surgeon gets visual aids in the endoscope image at the actual position, allowing him/her to manoeuvre a coagulation fibre into the right position. Finally, we outline how our registration algorithm can be used also for standard registration applications (establish the mapping between two sets of points). We propose our algorithm as a linear, non-iterative algorithm also for projective transformations and for 2D-3D-mappings. Thus, it can be seen as a generalization of the well-known Umeyama registration algorithm.     

第三脑室后部肿瘤行第三脑室底造瘘术及活检术疗效随访

目的 探讨第三脑室肿瘤合并脑积水使用神经内镜行第三脑室底造瘘术和活检术的手术方法和疗效.方法 收集北京天坛医院神经外科内镜组2009年1月至2012年12月期间收治的22例第三脑室肿瘤合并脑积水患者的临床资料、影像学和随访信息,分析该术式的疗效.结果 随访6个月～4.5年,22例患者中,术后临床症状完全消失18例;显著改善2例,其中1例仍有视物模糊,1例轻度头痛;恶化者2例,1例术后1个月发生全脑转移,1例术后1年复查头颅MRI显示肿瘤明显增大,2例患者均为星形细胞瘤Ⅲ级.随访发现17例患者肿瘤大小未见明显改变;3例明显缩小;1例患者发生全脑转移,经全脑放疗和化疗后症状改善;1例术后1年复查肿瘤明显增大,考虑接受显微外科切除术.结论 第三脑室后部占位多为低级别肿瘤,生长缓慢,可使用神经内镜进行第三脑室底造瘘术和活检术:前者治疗梗阻性脑积水,后者获取病理样本以指导后续治疗.     

神经内镜技术在联合入路治疗垂体腺瘤中的应用

目的 探讨神经内镜技术在分期手术时,采用经蝶窦和开颅联合入路治疗垂体腺瘤中的应用.方法 2009年3月至2013年3月天坛医院内镜神经外科专业组采用分期联合入路手术治疗32例垂体腺瘤患者,包括肿瘤残存患者20例,复发患者12例.分期手术中至少有一次为内镜下经鼻蝶窦入路手术.术后影像学检查确定肿瘤切除程度.结果 全切17例(53％),次全切4例(13％),大部切除7例(22％),部分切除4例(13％);其中残存肿瘤的全切率为35％(7/20),复发肿瘤的全切率为83％ (10/12).结论 神经内镜技术在分期手术联合入路治疗垂体腺瘤中具有重要应用价值.     

Neuroendoscopic options in the treatment of mesencephalic expanding cysts: Report of four cases and review of the literature

Objective

Mesencephalic expanding cysts, also called lacunae, are rare intraparenchymal, multilobulated cavities of variable diameter mostly localized in the thalamo-mesencephalic region. In symptomatic cases, usually presenting with hydrocephalus or midbrain syndrome, surgical treatment is required and, considering their position, a minimally invasive approach should be preferred.

Methods

Four cases of expanding mesencephalic cysts endoscopically treated in three different Italian centers are described. Other possible causes of intracerebral cyst were excluded in all cases by complete neuroimaging and laboratory screening. All patients presented with signs and symptoms of midbrain compression and a slight to moderate ventricular dilation was present in three cases.

Results

All patients underwent endoscopic cyst fenestration into the ventricle, associated with endoscopic third-ventriculostomy (ETV) in two cases and with cyst wall biopsy in one case. One patient suffered from transient worsening of her hemiparesis due to intraoperative bleeding. All patients showed clinical improvement and a reduction in cyst size on follow-up magnetic resonance images (MRI).

Conclusion

Neuroendoscopy appears to be an effective, probably definitive surgical option in the treatment of symptomatic mesencephalic expanding cysts. Associating ETV with cyst fenestration seems to offer more complete treatment. Deep intracystic navigation and cyst wall biopsy should be avoided.