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 the 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 the following categories according to the surgical modality.
(1) Endoscopic neurosurgery: pure application of neuroendoscopy, all surgical operations are done entirely through the endoscope, requiring the use of specialized endoscopic instruments to complete surgical operations through the endoscopic canal, commonly used for hydrocephalus, intracranial cystic lesions and and ventricular system lesions.
(2) Endoscopic-assisted microneurosurgery: In microneurosurgery, endoscopic assistance is used to explore and treat lesions in areas that are difficult to find with the microscope. The observation of areas beyond 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) Endoscopy-controlled microneurosurgery: Under the guidance of the endoscopic irradiation system and its display system, conventional microneurosurgical instruments are applied to complete the surgical operation through a small bone window or lockhole surgery.
The Department of Neurosurgery of the People’s Hospital of the Autonomous Region has held the first neuroendoscopic study class in Xinjiang in August 2006, which has achieved a great response in the neurosurgical community in Xinjiang. We also took the lead in carrying out the work of neuroendoscopy and achieved good results.
At present, our department has been equipped with neuroendoscopes including 0°, 30°, 70° lenses and matching surveillance system produced by Rudolf Company of Germany, has purchased microsurgical instruments matching with neuroendoscopes, and has been equipped with image recording system matching with endoscopic surveillance system.
The neuroendoscope has the following advantages
(1) Long endoscope body and small cross-section, suitable for operation in narrow spaces.
(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 locked hole surgery.
However, the technical complexity and difficulty of neuroendoscopic surgery are.
1, the surgical field location is deep in, the surgical space is narrow, the hard endoscope moving in the surgical field is easy to 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, neuroendoscopic surgery field is small, the operating space is small, the ability to cope with surgical accidents is poor, especially when there is more bleeding in the operating area, it is more difficult to deal with, so the operator is required to have a clear understanding of the relevant anatomical structures, and has received good training in endoscopic operation.
3. It requires the participation of material mechanics, tissue engineering, and neuroanatomical disciplines.
Neuroendoscopic surgery is suitable for.
1.Pituitary tumor: It avoids damage to nasal structures such as labiogingival incision, nasal septum free and large area stripping of nasal mucosa, 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, reducing 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 to treat arachnoid cyst has the advantages of small trauma, obvious improvement of clinical symptoms and smooth cerebrospinal fluid circulation.
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.