Liu Xi, Qiu Yan'kai, Zhang Fan, Wei Xiaoming, Zhou Zhisong, Zhang Feng, Xue Yiteng, Ma Zhaoru, Wang Xiaosong, Shen Hong, Lin Zhiguo, Shi Huaizhang, Liu Li
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Front Surg. 2022 Aug 23;9:933726. doi: 10.3389/fsurg.2022.933726. eCollection 2022.
Intraoperative hemorrhage represents a major risk during endoscopic intraventricular surgery. There are very few publications describing the maintenance of hemostasis during conventional endoscopic intraventricular surgery. Here, we designed a new mini-tubular port to combine intra- and extra-endoscopic techniques for endoscopic intraventricular surgery. With this new methodology, complicated techniques can be performed more efficiently with improved bleeding control.
The new mini-tubular port consists of an outer sheath and an obturator. The sheath is a thin-walled transparent cylinder that is 0.35 mm thick, 10 mm in diameter, and 90 mm in length. In this report, we describe the use of the mini-tubular port on 36 patients receiving endoscopic intraventricular surgery.
The study enrolled 36 patients, with a median age of 45 years (range: 0-72 years), of which 19 were male and 17 were female. Pure ETV (endoscopic third ventriculostomy) was performed in 20 patients and pure biopsy was performed in 2. ETV and biopsy were performed in five patients, ETV and the removal of cysticerci were performed in five, cyst fenestration was performed in one, ETV and cyst fenestration were performed in two, and ETV and shunt removal were performed in one patient. Two patients received microscopic surgery following endoscopic surgery during the same operation. A total of 17 patients (47%) underwent extra-endoscopic techniques. The median Karnofsky Performance Status (KPS) score of the patients prior to surgery was 50, while the median KPS score of the patients after one month of surgery was 80; these scores were significantly different ( < 0.05), as determined by Wilcoxon's test. In total, 27 patients had a KPS score ≥70% and 75% of patients had a favorable prognosis one month after surgery. None of the patients experienced seizure.
The new mini-tubular port can conveniently combine intra- and extra-endoscopic techniques for endoscopic intraventricular surgery. The application of these techniques can efficiently control bleeding during surgery, help improve the confidence of the surgeons involved, and provide a highly efficient approach for performing complicated procedures.
术中出血是内镜下脑室手术的主要风险。关于传统内镜下脑室手术中维持止血的文献非常少。在此，我们设计了一种新型微型管状端口，将内镜内和内镜外技术相结合用于内镜下脑室手术。采用这种新方法，可以更有效地实施复杂技术，并改善出血控制。
新型微型管状端口由一个外鞘管和一个闭孔器组成。鞘管是一个薄壁透明圆柱体，壁厚0.35 mm，直径10 mm，长度90 mm。在本报告中，我们描述了该微型管状端口在36例接受内镜下脑室手术患者中的应用。
该研究纳入36例患者，中位年龄45岁（范围：0 - 72岁），其中男性19例，女性17例。20例患者接受单纯内镜下第三脑室造瘘术（ETV），2例接受单纯活检。5例患者接受ETV和活检，5例接受ETV和囊尾蚴摘除术，1例接受囊肿开窗术，2例接受ETV和囊肿开窗术，1例接受ETV和分流管取出术。2例患者在同一手术过程中内镜手术后接受了显微手术。共有17例患者（47%）接受了内镜外技术。患者术前的中位卡诺夫斯基功能状态（KPS）评分为50分，而术后1个月患者的中位KPS评分为80分；经威尔科克森检验确定，这些评分有显著差异（<0.05）。总共有27例患者KPS评分≥70%，75%的患者术后1个月预后良好。所有患者均未发生癫痫。
新型微型管状端口可方便地将内镜内和内镜外技术相结合用于内镜下脑室手术。这些技术的应用可有效控制手术中的出血，有助于提高参与手术的外科医生的信心，并为实施复杂手术提供一种高效的方法。
