脑立体定向内窥镜的研制及其临床应用

Development and clinical application of a brain stereotactic endoscope

目的探讨经内窥镜切除脑肿瘤的可行性、适应证及优越性。方法自行设计生产一种工作道相对宽大、能在脑实质中进行操作的脑立体定向内窥镜，用来进行脑深部肿瘤切除手术和其它颅脑手术。临床试用３０例：颅内肿瘤１３例，颅内血肿１５例，脑脓肿１例，脑囊虫病１例。结果肿瘤全切除４例，次全及大部切除７例，活检２例。血肿全清除７例，大部清除８例。脑脓肿吸除１例，脑囊虫孤立病灶切除１例。全组术后无严重并发症。结论脑立体定向内窥镜切除脑深部肿瘤定位准确、损伤小，其适应证为边界清楚、血供不丰富的微小肿瘤。直视下迅速清除脑内血肿，能止血。

Objective To investigate the feasibility,indications and advantages of endoscopic surgery for brain neoplasms and hypertensive haematoma. Method A self-diesigned brain endoscope with a wide working channel was used for resection of deepseated brain neoplasm or other cranial cerebral operations of 30 patients operated on endoscopically, 13 had intracranial tumor,15 hypertensive intracerebral haematoma,1 thalamic abscess, and 1 cysticercosis. Result Total removal of tumor was achieved in 4 patients, subtotal or major partial removal in 7, and biopsy in 2. Compeletely evacuation of haematoma was achieved in 7 patients and partial evacuation in 8 (over 80%).The abscess was evacuated and the solitary cysticercosis focus was removed with our endoscope.No obvious postoperative complications were noted. Conclusion The advantages of stereotactic endoscopy for deepseated brain neoplasm include accurate intraoperative localization,minimal invasion,good recovery,no or a few complications. The indications for this intervention are small lesions deep in the brain parenchyma with welldefined boundary and light vascularity.Intracerebral haematoma can be evacuated under direct vision endoscopically,without damage to the haematoma cavity wall.