神经内窥镜技术的临床应用

Clinical application of the neuroendoscopic techniques

目的 探讨微侵袭内窥镜神经外科的手术技术方法。方法 应用单纯内窥镜手术(EN) ,内窥镜辅助的显微神经外科 (EAM) ,内窥镜控制的显微神经外科 (ECM) ,并结合立体定向、激光等技术 ,治疗各种神经外科疾病 84例。其中各类颅内囊肿 33例 ,脑囊虫 6例 ,脑积水 16例 ,颅内肿瘤 15例 ,颅内血肿 8例 ,立体定向和姑息性手术 6例。结果 对颅内囊肿应用EN治疗 2 1例 ,ECM10例 ,EAM2例 ,其中 30例术前症状改善 ;颅内肿瘤用EN切除 1例 (1 5cm直径 ) ,ECM全切 5例 ,EAM全切 9例 ,其中 13例症状缓解 ,1例无变化 ;6例脑囊虫均用EN摘除 ,效果良好 ,无并发症 ;其余 30例 (脑积水、活检、血肿、肿瘤姑息手术 )均行EN手术 ,2 6例改善症状。 84例中有 4例出现并发症 ,包括蛛网膜下腔出血、脑室内出血和一过性心肺功能异常。结论 (1)神经内窥镜对颅内囊性病变、脑室内病灶、脑积水、脑囊虫和颅内深在的小病灶有独到的价值。 (2 )神经内窥镜对显微外科手术有辅助作用 ,可以提高手术质量。 (3)神经内窥镜手术操作简便、损伤小、术后反应轻 ,可减少治疗费用 ,缩短住院时间。

Objective To discuss the techniques and methods of minimally invasive endoscopic neurosurgery. Methods Using endoscopic neurosurgery(EN), endoscopy assisted microneurosurgery(EAM), endoscopy controlled microneurosurgery(ECM), and combining endoscopy with stereotactic and laser technique, 84 cases with different neurosurgical disease were treated. There were 33 intracranial cysts , 6 brain cysticercosis, 16 hydrocephalus, 15 brain tumors, 8 intracranial hematoma and 6 others. Results 21 cases of 33intracranial cysts were treated with EN , 10 cases with ECM, 2 cases with EAM; 30 cases of them improved after operation. For patients with tumors, EN was used in 1 cases, ECM in 5 cases, EAM in 9 cases, symptomatic improvement were achieved in 14 of 15 patients, unchanged in 1 case. 6 brain cysticercosis were treated with EN and had a good effect. 30 others (hydrocephalus, biopsy, hematoma and so on)were treated with EN, 26 cases of them were improved. 4 of 84 cases appeared complicated with SAH, intraventricular hemorrhage, instant cardiopulmonary dysfunction. Conclusion (1) Neuroendoscopy in highly valuable in the treatment on intracranial cyst; (2) Neuroendoscopy may assist the microneurosurgery to improve operative quality; (3) The manipulation of neuroendoscopy is simple, less expensive shorter hospitalization, less operative trauma reaction.