神经内镜在微侵袭神经外科手术中的应用

Applications of neuroendoscope in neurosurgery

目的探讨内镜在微侵袭神经外科手术中的应用。方法应用内镜辅助的显微神经外科(EAM)对36例垂体瘤行经鼻蝶入路手术;结合立体定向技术对22例脑积水,11例颅内囊性病变及1例侧脑室内囊虫病进行单纯内镜手术(EN);应用内镜控制的显微神经外科(ECM)技术对10例三叉神经痛进行微血管减压术。结果36例垂体瘤中24例全切除,12例次全切除。21例梗阻性脑积水术后脑室缩小,1例术后复发;9例颅内囊性病变术后囊腔缩小,2例出现并发症,1例侧脑室内囊虫病病灶完整摘除;10例桥小脑角微血管减压术应用内镜效果满意。结论经鼻蝶入路手术中,内镜可以更充分显露并完全切除鞍区肿瘤。可以同期在直视下进行第三脑室底部造瘘及立体定向活检术;可直视下对颅内囊性病灶进行穿刺冲洗、活检、房腔贯通等操作。可从不同角度观察了解桥小脑角显微解剖结构,微创直观。

Objective To discuss the application of endoscopy in neurosurgery. Methods 36 cases of transsphenoidal pituitary operations were performed with endoscope-assisted microsurgery(EAM); 22 obstructive hydrocephalus, 6 colloid cysts, 5 cystic craniopharygioma and l cysticercosis of lateral ventricle were treated by endoscopic neurosurgery (EN) combining with stereotactic technique; l0 cases in cerebellopontine angle (CPA) microvascular decompression were treated with endoscopy-controlled microneurosurgery (ECM). Results 24 cases of pituitary adenomas were resected totally, 12 were resected subtotally. The size of ventricles in 2l of 22 cases with obstructive hydrocephalus were markedly decreased,one case was reoccurred; The cystic cavity of 9 intracrainial cystic lesions were markedly decreased, complications were presented in 2 cases. 10 cases of CPA microvascular decompression were performed with endoscopic technique, postoperative outcome was good. Conclusion During endoscopic transsphenoidal sellar tumor resection, we can get a good operation field and the tumor can be resected totally. Stereotactic biopsy combining with third ventriculostomy can be used at the same time in vision.Intracrainial cyst can be punctured,irrigated, biopsy and penetrated the wall of the cyst. By endoscopic technique, CPA microanatomy during microvascular decompression can be observed from different angles with minimal invasion.