Endoscopic techniques as a diagnostic and therapeutic tool have been widely used in many disciplines, but neurosurgery was the last surgical field to adopt endoscopic techniques due to the relatively small space available for operation in the brain.
In the early days, there was no real neuroendoscopy, and neurosurgeons mostly borrowed endoscopes from other clinical disciplines to operate and only used them to try to treat hydrocephalus, but because the endoscopic tubes used at that time were coarse, the optical quality of illumination was poor, and there was a lack of corresponding surgical instruments therefore the surgery was traumatic, ineffective, and the mortality rate was high.
In the 1980s, driven by relevant scientific progress, endoscopy and its supporting instruments were updated at a significantly faster rate, and gradually developed in the direction of small size, high resolution and stereoscopic magnification, through which complex operations such as illumination, irrigation, suction, hemostasis, cutting, balloon dilation, photography and video can be performed. In 1988, Austrian neurosurgeon Auer formally proposed the concept of “endoscopic neurosurgery”, marking the establishment of a new branch of neurosurgery.
With the continuous expansion of equipment and technology, the future of endoscopic neurosurgery is increasingly broad. Currently, neuroendoscopic surgery is divided into: (1) endoscopic neurosurgery: the application of neuroendoscopy alone, all surgical operations are completed entirely through the endoscope, requiring the use of specialized endoscopic instruments through the endoscopic canal to complete the surgical operation, commonly used in hydrocephalus, intracranial cystic lesions and and ventricular system lesions (2) endoscopy-assisted microneurosurgery: is the application of (2) Endoscopy-assisted microneurosurgery: This is the application of endoscopic assistance in microneurosurgery to explore and treat lesions in dead-end areas that are difficult to detect with the microscope. The observation of the area outside of the direct microscopic view of the operative field not only increases the exposure of the operative field and avoids missing lesions, but also alleviates postoperative reactions. It is commonly used for aneurysm clamping, triple* nerve decompression, and cholesteatoma resection in the pontocerebellar horn region. (3) Endoscopic controlled micro-neurosurgery: Under the guidance of the endoscopic irradiation system and its display system, conventional micro-neurosurgical instruments are applied to complete the surgical operation through small bone windows or lockhole surgery.
The Department of Neurosurgery of the First Affiliated Hospital of Jinan University has held two neuroendoscopic study courses in Guangzhou in 2012 and 2013, which have achieved great repercussions in the neurosurgical community in South China. We also took the lead in neuroendoscopic work and achieved fruitful results.
At present, our department has the neuroendoscope including 0°, 30°, 70° lens and matching surveillance system produced by Rudolf Company of Germany, has purchased microsurgical instruments matching with neuroendoscope, and has the image recording system matching with endoscopic surveillance system.
The neuroendoscope has the following advantages (1) long endoscope body and small cross-section, which is suitable for operation in narrow space. (2) Good illumination and clear field of view. The microscope light source has produced a great attenuation of luminance when reaching deeper surgery, while the endoscope is close illumination, and the clarity of the deep surgical field is significantly better than that of the operating microscope. (3) Endoscopy-controlled micro-neurosurgery: Under the guidance of the irradiation system of the endoscope and its display system, conventional micro-neurosurgical instruments are applied to complete the surgical operation through a small bone window or lockhole surgery.
However, the technique of neuroendoscopic surgery is complicated and difficult: 1 The surgical field location is deep in, the surgical space is narrow, and the movement of the rigid endoscope in the surgical field can easily cause adjacent vascular and nerve injury, especially when using an angled endoscope, the monitor shows the image of the side of the endoscope, which is more likely to cause collateral damage. 2 The neuroendoscopic surgical field is small, the operating space is small, and the ability to cope with surgical accidents is poor, especially when the operating area It is more difficult to handle when there is more bleeding, thus requiring the operator to have a clear understanding of the relevant anatomical structures and to be well trained in endoscopic operations.3 Involvement of the disciplines of material mechanics, tissue engineering, and neuroanatomy is required.
Neuroendoscopic surgery is suitable for: 1. Pituitary tumor: It avoids damage to nasal structures such as labiogingival incision, nasal septum free and large area of nasal mucosa stripping, and reduces complications such as atrophic rhinitis, labiogingival sensory loss and gingival atrophy. It is easy to grasp the removal of tumor, and basically can remove the tumor in the envelope cleanly, which can reduce the damage to pituitary gland and surrounding important structures, and hemostasis can be *, which reduces the possibility of postoperative bleeding.
2, hydrocephalus: restoring the normal circulation of cerebrospinal fluid can avoid craniotomy, which can be achieved only through micro-osseous approach.
3, arachnoid cyst: the application of neuroendoscopy for the treatment of arachnoid cyst has the advantages of less trauma, obvious improvement of clinical symptoms and smooth circulation of cerebrospinal fluid.
4.Intracerebral tumor: Endoscopic resection of intracerebral tumor has unique advantages. Clinical practice proves that its surgical damage is small, and its accuracy in judging ectopic tumor, early tumor implantation or metastasis is much higher than that of CT or MRI imaging, which is an important guidance for further treatment of tumor. Intracerebroventricular tumor resection surgery has little side injury, quick recovery, few adverse effects or complications, and is often transient. If the surgical anatomical location is accurate and the resection scope is appropriate, permanent complications are less likely to occur.
5. Skull base tumor: transnasal endoscopic skull base extension approach for resection of chordoma utilizes congenital structures, wide range of lesion resection, and low morbidity and mortality rate. Our department has carried out transnasal chordotomy, which is leading in the northwest.