微侵袭神经内镜技术的应用

目的总结和分析内镜技术在神经外科的应用,探讨内镜在神经外科临床疾病诊断治疗中的意义.方法应用神经内镜技术和内镜辅助的显微神经外科技术诊断治疗各种神经外科疾病患者1 300例.其中单纯应用神经内镜手术522例,内镜辅助显微神经外科260例,内镜引导下锁孔手术79例,内镜引导下经鼻蝶手术治疗鞍区病变434例,其他方法5例.结果脑积水362例全部应用单纯内镜技术,其中三脑室底造瘘190例,辅助分流管放置30例,另有142例复杂性脑积水和不对称性脑积水施行内镜下脑室病理分隔造瘘、透明隔造瘘和炎性脑室治疗,术后94.2%(341/362)的患者临床症状得到改善.颅内各种囊肿160例,行单纯内镜下摘除和部分摘除及囊肿脑室造瘘82例,92.7%(76/82)的患者临床症状好转;行内镜锁孔下手术70例,辅助显微神经外科8例,均全部切除囊肿,术后恢复良好.260例颅内肿瘤中252例在内镜辅助的显微神经外科下切除(其中190例为胆脂瘤),8例在单纯内镜下切除,均为脑室内小于2.5 cm的肿瘤,术后87.7%(228/260)的患者临床症状得到改善.脑室、脑池内囊虫49例,40例在单纯内镜下摘除,9例在内镜下锁孔摘除,手术顺利,术后均改善症状.内镜引导下经鼻蝶手术治疗鞍区病变434例,其中垂体瘤387例,脑脊液漏修补19例,脊索瘤9例,其他19例,88.9%(386/434)的患者临床症状得到改善.另有5例患者采用导航立体定向配合内镜技术,手术效果良好.2%(26/1 300)的患者术后出现并发症,表现为术中出血、感染、重要结构损伤.结论神经内镜技术的应用可以减少以往单纯开颅手术带来的创伤,在尽可能保护正常组织的同时,最大限度的去除病变,有助于提高疗效,减少并发症.

Clinical application of minimally invasive neuroendoscopic techniques

Objective To summarize and analyze the application of neuroendoscopic techniques in neurosurgery, and to discuss the role and significance of neuroendoscopic techniques in the diagnosis and treatment of neurosurgical diseases. Methods We treated 1 300 patients with different neurosurgical diseases by performing endoscopic neurosurgery(EN)and endoscopy-assisted microneurosurgery(EAM). Among 1 300 paitents, 522 were treated with pure endoscopic neurosurgery, 260 with endoscopy-assisted microneurosurgery, 79 with endoscope-controlled bur hole trephination neurosurgery, 434 with endoscope transsphenoidial surgery, and 5 with other techniques through which an endoscope was used in conjunc-tion with stereotactic guidance. Results Totally 362 hydrocephalus patients were treated using EN. Among them, 190 were treated by third ventriculostomy, 30 by V-P shunt, and 142 patients with compli-cated hydrocephalus and unsymmetry hydrocephalus by endoscopy-controlled phathologic septum fenestrat-ion, septum pellucidum fenestration, and treatment of inventricula inflammation. Clinical symptomatic imp-rovement was achieved in 341 of 362 patients(94.2%). Also 160 intracranial cyst patients were treated using EN for resection and partial resection. Eighty-two patients were performed through cyst-ventricula fenestration. Clinical symptomatic improvement was achieved in 76 of 82 patients(92.7%). Seventy patients treated with endoscopy-controlled bur hole neurosurgery and 8 cases with endoscopy-assisted microneurosurgery got better recovery after operation. Among 260 patients with brain tumors, 252 patients were operated with EAM(190 patients with epidermoid cyst), 8 patients with EN(all brain tumors with diameters < 2.5 cm in inventricular). Clinical symptomatic improvement was achieved in 228 of 260 patients(87.7%). Among 49 patients with inventricular and cistern cyst, 40 patients who were treated by EN and 9 patients by endoscopy-controlled bur hole neurosurgery were resected and their clinical symptoms were improved after operation. Among 434 patients with sellar region lesions, 387 patients with pituitary adenomas, 19 patients with repair for CSF leaks, 9 patients with chordoma,and 19 patients with other neurosurgical diseases were performed with endoscopy-controlled transsphenoidial surgery. Clinical symptoms in 88.9%(386/434)of these patients were improved. Another 5 patients were treated with endoscopy combined with navigation and stereotatic guidance with good results. The complications related to operation were found in only 2% of all the patients including hemorrhage, infection, and damage of important structure. Conclusions Clinical application of neuroendoscopic techniques can decrease the damage caused by pure open surgery operation. It is possible to resect lesions at the utmost and protect normal tissue from lesions for using EN and EAM or endoscopy-controlled microneurosurgery(ECM). It is also helpful to enhance surgical quality and reduce the complications.