Koueik Joyce, Rocque Brandon G, Henry Jordan, Bragg Taryn, Paul Jennifer, Iskandar Bermans J
J Neurosurg Pediatr. 2018 Feb;21(2):171-177. doi: 10.3171/2017.8.PEDS1726. Epub 2017 Dec 8.
Continuous irrigation is an important adjunct for successful intraventricular endoscopy, particularly for complex cases. It allows better visualization by washing out blood and debris, improves navigation by expanding the ventricles, and assists with tissue dissection. A method of irrigation delivery using a centrifugal pump designed originally for cardiac surgery is presented. The BioMedicus centrifugal pump has the desirable ability to deliver a continuous laminar flow of fluid that excludes air from the system. A series of modifications to the pump tubing was performed to adapt it to neuroendoscopy. Equipment testing determined flow and pressure responses at various settings and simulated clinical conditions. The pump was then studied clinically in 11 endoscopy cases and eventually used in 310 surgical cases. Modifications of the pump tubing allowed for integration with different endoscopy systems. Constant flow rates were achieved with and without surgical instruments through the working ports. Optimal flow rates ranged between 30 and 100 ml/min depending on endoscope size. Intraoperative use was well tolerated with no permanent morbidity and showed consistent flow rates, minimal air accumulation, and seamless irrigation bag replacement during prolonged surgery. Although the pump is equipped with an internal safety mechanism to protect against pressure buildup when outflow obstructions occur, equipment testing revealed that flow cessation is not instantaneous enough to protect against sudden intracranial pressure elevation. A commonly available cardiac pump system was modified to provide continuous irrigation for intraventricular endoscopy. The system alleviates the problems of inconsistent flow rates, air in the irrigation lines, and delays in changing irrigation bags, thereby optimizing patient safety and surgical efficiency. Safe use of the pump requires good ventricular outflow and, clearly, sound surgical judgment.
持续冲洗是成功进行脑室内内镜检查的重要辅助手段，尤其是对于复杂病例。它通过冲洗出血液和碎屑实现更好的视野，通过扩张脑室改善导航，并有助于组织分离。本文介绍了一种使用最初为心脏手术设计的离心泵进行冲洗的方法。百多力离心泵具有输送连续层流液体的理想能力，可将空气排除在系统之外。对泵管进行了一系列修改，使其适用于神经内镜检查。设备测试确定了在各种设置和模拟临床条件下的流量和压力响应。然后对该泵进行了11例内镜检查病例的临床研究，最终用于310例手术病例。泵管的修改使其能够与不同的内镜系统集成。通过工作端口，无论有无手术器械，都能实现恒定的流速。根据内镜尺寸，最佳流速范围为30至100毫升/分钟。术中使用耐受性良好，无永久性并发症，且在长时间手术中流速一致、空气积聚极少、冲洗袋更换无缝隙。尽管该泵配备了内部安全机制，以防止流出道梗阻时压力升高，但设备测试表明，流量停止不够迅速，无法防止颅内压突然升高。对一种常用的心脏泵系统进行了改进，以提供脑室内内镜检查的持续冲洗。该系统缓解了流速不一致、冲洗管路中有空气以及冲洗袋更换延迟等问题，从而优化了患者安全和手术效率。安全使用该泵需要良好的脑室流出道，显然还需要合理的手术判断。
