Casas Carlos E, Guest James D
Miami Project to Cure Paralysis, University of Miami, 1095 NW 14th Terrace, Miami, FL 33136, USA.
Neurosurgery. 2004 Apr;54(4):950-5; discussion 955. doi: 10.1227/01.neu.0000115673.14729.7d.
To explore the feasibility of performing percutaneous endoscopic cellular transplantation into the lumbar spinal cord of pigs to create intramedullary cellular trails.
The lumbar subarachnoid space was accessed using a 10-gauge needle inserted between L5 and L6. A 12.5-French flexible introducer sheath was fed over the needle into the subarachnoid space. A 3.2-mm-diameter flexible, steerable endoscope was then directed intradurally through the sheath. The thecal space was distended by saline infusion. A microcatheter with an attached needle then was advanced through the working channel into the dorsal surface of the lumbar spinal cord. Five microliters of Hoechst-labeled fibroblasts were injected while the catheter was withdrawn slowly to create a trail of cells within the spinal cord. The spinal canal then was perfused with fixative. The injected spinal cord segment was removed and studied histologically. Endoscopic video was analyzed offline.
The endoscope could be navigated under visual guidance. The sacral and lumbar rootlets, the spinal cord, and associated vessels were visualized. In fixed sagittal sections, a linear trail of fluorescent fibroblasts could be seen within the lumbar spinal cord in each specimen.
Percutaneous endoscopic cellular injection may be useful for cellular transplantation, may reduce surgical and anesthetic time, may be compatible with local anesthesia, may eliminate the need to disrupt spinal instrumentation and bone grafts, and may allow greater flexibility in the respective timing of spinal fixation and cellular transplantation after spinal cord injury. This is the first report of the use of endoscopic intraspinal cellular transplantation.
探讨经皮内镜下将细胞移植到猪腰段脊髓以形成髓内细胞轨迹的可行性。
使用10号穿刺针在L5和L6之间穿刺进入腰段蛛网膜下腔。将一根12.5法式的可弯曲导入鞘沿穿刺针送入蛛网膜下腔。然后将一根直径3.2毫米的可弯曲、可操控的内镜经鞘管硬膜内插入。通过注入生理盐水使鞘膜腔扩张。接着将一根带有 attached needle的微导管经工作通道推进至腰段脊髓背侧表面。在缓慢回撤导管的同时注入5微升经Hoechst标记的成纤维细胞，以在脊髓内形成细胞轨迹。随后用固定剂灌注椎管。取出注入细胞的脊髓节段并进行组织学研究。对内镜视频进行离线分析。
内镜可在视觉引导下操作。可见骶神经根和腰神经根、脊髓及相关血管。在固定的矢状切片中，每个标本的腰段脊髓内均可看到一条荧光成纤维细胞的线性轨迹。
经皮内镜下细胞注射可能有助于细胞移植，可减少手术和麻醉时间，可能适用于局部麻醉，可避免破坏脊柱内固定器械和骨移植，并且在脊髓损伤后脊柱固定和细胞移植的各自时机选择上可能具有更大灵活性。这是关于内镜下脊髓内细胞移植应用的首次报道。
