Neurosurgery is a highly specialized field:it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions.There are still no reliable met...Neurosurgery is a highly specialized field:it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions.There are still no reliable methods preventing possible retraction complications.The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue.The chamber is designed to be inserted close to the intracranial point of interest;once it is best placed it can be opened.This should guarantee an appreciable workspace similar to that of current neurosurgical procedures.The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase.Following pterional craniotomy,pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations.Note that,although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same,the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly.A new method of cerebral retraction using a chamber retractor(CR)has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma.展开更多
目的探讨神经内镜联合Viewsite脑牵开器手术治疗重度脑室出血(IVH)铸型的临床效果。方法回顾性分析解放军联勤保障部队第九〇一医院神经外科自2018年1月至2021年1月收治的26例重度IVH铸型患者的临床资料,其中12例患者行神经内镜联合View...目的探讨神经内镜联合Viewsite脑牵开器手术治疗重度脑室出血(IVH)铸型的临床效果。方法回顾性分析解放军联勤保障部队第九〇一医院神经外科自2018年1月至2021年1月收治的26例重度IVH铸型患者的临床资料,其中12例患者行神经内镜联合Viewsite脑牵开器经侧脑室额角入路手术清除脑室内血肿,为手术组;14例患者采用侧脑室额角钻孔置管外引流,为对照组。对比2组患者术后6 h、3 d的血肿清除率、术后6 h Graeb评分和脑室颅腔比(VCR)值的变化、引流管留置时间、甘露醇使用量及使用时间、神经重症监护单元(NICU)住院时间、术后14 d GCS评分的变化、术后并发症(再出血、肺部感染、颅内感染及迟发性脑积水)的发生率。术后随访6个月,采用改良的Rankin量表(mRs)及额叶功能评定量表(FAB)评估2组患者的额叶功能损害程度。结果相较于对照组,手术组患者术后血肿残余量减少,术后6 h Graeb评分及VCR值降低,引流管留置时间缩短,甘露醇使用减少,NICU住院时间缩短及术后2周GCS评分提高,术后颅内感染和迟发性脑积水的发生率降低,术后6个月mRs神经功能评分提高,差异均有统计学意义(P<0.05),而2组患者术后再出血和肺部感染的发生率以及FAB评分比较,差异无统计学意义(P>0.05)。结论神经内镜联合Viewsite脑牵开器手术治疗重度IVH铸型能够快速清除脑室内血肿,尽早恢复脑室再通,降低脑室系统的被动扩张,改善患者的生存质量。展开更多
文摘Neurosurgery is a highly specialized field:it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions.There are still no reliable methods preventing possible retraction complications.The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue.The chamber is designed to be inserted close to the intracranial point of interest;once it is best placed it can be opened.This should guarantee an appreciable workspace similar to that of current neurosurgical procedures.The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase.Following pterional craniotomy,pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations.Note that,although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same,the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly.A new method of cerebral retraction using a chamber retractor(CR)has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma.
文摘目的探讨神经内镜联合Viewsite脑牵开器手术治疗重度脑室出血(IVH)铸型的临床效果。方法回顾性分析解放军联勤保障部队第九〇一医院神经外科自2018年1月至2021年1月收治的26例重度IVH铸型患者的临床资料,其中12例患者行神经内镜联合Viewsite脑牵开器经侧脑室额角入路手术清除脑室内血肿,为手术组;14例患者采用侧脑室额角钻孔置管外引流,为对照组。对比2组患者术后6 h、3 d的血肿清除率、术后6 h Graeb评分和脑室颅腔比(VCR)值的变化、引流管留置时间、甘露醇使用量及使用时间、神经重症监护单元(NICU)住院时间、术后14 d GCS评分的变化、术后并发症(再出血、肺部感染、颅内感染及迟发性脑积水)的发生率。术后随访6个月,采用改良的Rankin量表(mRs)及额叶功能评定量表(FAB)评估2组患者的额叶功能损害程度。结果相较于对照组,手术组患者术后血肿残余量减少,术后6 h Graeb评分及VCR值降低,引流管留置时间缩短,甘露醇使用减少,NICU住院时间缩短及术后2周GCS评分提高,术后颅内感染和迟发性脑积水的发生率降低,术后6个月mRs神经功能评分提高,差异均有统计学意义(P<0.05),而2组患者术后再出血和肺部感染的发生率以及FAB评分比较,差异无统计学意义(P>0.05)。结论神经内镜联合Viewsite脑牵开器手术治疗重度IVH铸型能够快速清除脑室内血肿,尽早恢复脑室再通,降低脑室系统的被动扩张,改善患者的生存质量。
