Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
World Neurosurg. 2019 May;125:e978-e983. doi: 10.1016/j.wneu.2019.01.219. Epub 2019 Feb 11.
Three-dimensional (3D), high-definition (HD) endoscopy has been recently introduced in neurosurgery, and its value has been discussed extensively in endonasal skull base surgery. Because there has been no reported clinical series on the use of a recent 3D-HD ventriculoscope, the aim of this study was to describe our initial experience with this novel device.
Patients consecutively operated on from June 2016 to June 2018 with a 3D-HD ventriculoscope were prospectively collected. The system is a 6-mm, 0-degree optic with a 105-degree field of view, with a central working channel of 2.2-mm diameter and 2 side channels of 1.3-mm diameter. Patients' demographic data, preoperative symptoms, and neurologic status; neuroradiologic data; type of surgery; operative time; intraoperative and postoperative complications, and follow-up data were prospectively recorded and retrospectively reviewed.
Twenty-four patients (age range: 3-84 years) underwent 25 procedures including endoscopic third ventriculocisternostomy, biopsy, and cyst fenestration. The technical goal of surgery was obtained in all patients. There were no intraoperative complications, expect for 1 intraoperative epileptic seizure. Postoperative complications included asymptomatic subdural collections in 2 patients, infection, and delayed endoscopic third ventriculocisternostomy closure in 1 patient each. Relative limits of the system are its size and the availability of only a 0-degree optic. Image quality appeared satisfactory in all procedures. The lack of a dedicated introducer was resolved, exploiting a vascular "peel-away" system.
3D-HD technology seems to provide potential advantages in ventricular surgery. This initial experience is promising but must be confirmed by larger series.
三维(3D)高清内镜技术最近被引入神经外科领域,其在内鼻腔颅底手术中的应用价值已得到广泛讨论。由于目前尚无关于使用新型 3D-HD 脑室镜的临床报道,本研究旨在介绍我们应用该新型设备的初步经验。
本研究前瞻性收集了 2016 年 6 月至 2018 年 6 月期间连续接受 3D-HD 脑室镜手术的患者资料。该系统为 6mm 零角度光学镜,具有 105°视野,中央工作通道直径为 2.2mm,2 个侧通道直径为 1.3mm。患者的人口统计学数据、术前症状和神经状态;神经影像学数据;手术类型;手术时间;术中及术后并发症,以及随访资料均被前瞻性记录,并进行了回顾性分析。
24 例患者(年龄 3-84 岁)接受了 25 例手术,包括内镜下第三脑室造瘘术、活检和囊肿开窗术。所有患者均达到了手术的技术目标。术中无并发症,仅 1 例患者发生术中癫痫发作。术后并发症包括 2 例无症状性硬膜下积液、1 例感染和 1 例内镜下第三脑室造瘘术关闭延迟。该系统的相对局限性在于其尺寸以及仅提供 0 度光学镜。所有手术中图像质量均令人满意。缺乏专用导入器的问题通过血管“剥脱”系统得到了解决。
3D-HD 技术似乎为脑室手术提供了潜在的优势。本初步经验令人鼓舞,但仍需更大系列研究加以证实。