便携式神经内镜在脑内血肿清除术和开放性颅脑损伤有限清创术中的应用

Application of portable neuroendoscopy in intracerebral hematoma removal and open traumatic brain injury undergoing limited debridement

目的探讨便携式神经内镜在脑内血肿清除术和开放性颅脑损伤有限清创术中的应用价值。方法在头颅模型内注入硅胶作为脑实质,用垂物法投入模拟血包,制作脑内血肿,应用便携式神经内镜模拟清除脑内血肿;取10只比格犬制作开放性颅脑损伤模型,应用便携式神经内镜模拟进行有限清创术。结果5例脑内血肿模拟清除术均顺利完成,血肿量为(30.00±7.91)ml,血肿清除时间为(1.28±0.45)min,血肿清除效率为(24.05±2.51)ml/min,血肿清除体积为(27.20±6.83)ml,血肿清除率为(90.98±2.73)%。10只比格犬开放性颅脑损伤模型在便携式超声实时引导下完成有限清创术,异物数量为(4.00±1.49)个,手术时间为(25.20±9.66)min,异物取出数量为(2.90±1.10)个,单个异物清除时间为(9.50±2.83)min,异物清除率为(73.17±16.22)%;手术前后CT示颅内无继发性出血,但是积气增多。结论利用便携式神经内镜对脑内血肿进行血肿清除术,或对开放性颅脑损伤进行有限清创术,都是可行、有效的。

Objective To explore the application value of portable neuroendoscopy in the removal of intracerebral hematoma and limited debridement of open traumatic brain injury(TBI).Methods Five simulate cerebral hematomas were made artificially:silica gel was injected into the resin skull model as the cerebral substance and the simulated blood pack was put into the silica gel to make intracerebral hematoma,and then the portable neuroendoscope was used to remove the simulated intracerebral hematomas.Ten beagle dogs were used to make an open TBI model and the portable neuroendoscopy was used to simulate the limited debridement.Results All the simulated removal of cerebral hematomas were successfully completed.The volume of hematoma was(30.00±7.91)ml,the time of hematoma removal was(1.28±0.45)min,the efficiency of hematoma removal was(24.05±2.51)ml/min,and the volume of hematoma removal was(27.20±6.83)ml,the clearance rate of hematoma was(90.98±2.73)%.The limited debridements under guidance of portable real-time ultrasound were successfully completed in 10 beagle dogs with open TBI model.The number of foreign bodies was(4.00±1.49),the operation time was(25.20±9.66)min,the number of removed foreign bodies was(2.90±1.10),the removal time of a single foreign body was(9.50±2.83)min,and the foreign body removal rate was(73.17±16.22)%;After the limited debridement,CT showed no secondary intracranial hemorrhage and increase in intracranial pneumatocele.Conclusions It is feasible and effective to use portable neuroendoscopy to remove intracerebral hematoma or perform limited debridement for open TBI.