Efficacy of neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle in patients with Chiari malformation type I / 中华神经医学杂志

Objective:To explore the treatment efficacy of neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle in patients with Chiari malformation type I.Methods:Ninety-five patients with Chiari malformation type I, admitted to our hospital from January 2016 to January 2020, were chosen in our study. Patients from observation group ( n=57) were treated with posterior cranial fossa decompression+subdural tonsillectomy+endoscope-assisted exploration and release of the outflow tract of the fourth ventricle+enlarged reconstruction of the occipital cistern. Patients from control group ( n=38) were treated with posterior fossa decompression+subdural tonsillectomy+enlarged reconstruction of the occipital cistern. All patients were followed up for one year. Data of surgical duration, intraoperative blood loss, postoperative length of hospital stay, and incidence of complications were retrospectively analyzed in patients from the two groups, and the imaging changes of spinal cavity were observed before surgery and during postoperative follow-up. Chicago Chiari Outcome Scale (CCOS) was used to evaluate the prognoses of all patients (scores of 11-16 were defined as good prognosis). The differences of good prognosis rate among patients with different gender, age, degrees of tonsillar herniation and distributions of spinal cavity segments were analyzed. Results:There was no significant difference in surgical duration, intraoperative blood loss, postoperative length of hospital stay or incidence of complications between the two groups ( P>0.05). As compared with the control group (65.5%), the observation group had higher syringomyelia minification (75.5%) during postoperative follow-up, without significant difference ( P>0.05). The good prognosis rate of the observation group during postoperative follow-up (91.2%) was significantly higher than that of the control group (78.9%, P<0.05). Female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas had significantly higher good prognosis rate than male patients, patients with age>45 years, and patients with tonsillar herniation level between the foramen magnum and the atlas during postoperative follow-up, respectively ( P<0.05). Conclusion:As compared with conventional surgery, neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle is more effective in patients with Chiari malformation type I, and the good prognosis rate is likely higher in female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas.

Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection: an application and follow-up study / 中华神经医学杂志

Objective:To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods:A retrospective analysis was performed. Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen; their clinical data were collected. The surgical processes and complications were concluded, and the prognoses were evaluated by modified Rankin scale (mRS).Results:One patient was treated with intraoperative simple tamponade compression for hemostasis, and died for massive intracranial hemorrhage 2 weeks after surgery. Five patients were occluded by Willis covered stents; the occluded success rate was 100% but ophthalmic arteries were blocked in all. During the perioperative period, diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient; 5 patients were followed up for 3-12 months: MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient, no new bleeding or ischemic stroke events occurred in these 5 patients, and the prognosis was good.Conclusion:Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.

Neuroendoscopy in microsurgical clipping for ruptured posterior communicating artery aneurysms via keyhole approaches / 中华显微外科杂志

Objective:To explore the value of application and manipulation technique of neuroendoscope in microsurgical clipping of ruptured posterior communicating artery(PCoA)aneurysms via keyhole approaches.Methods:From January 2018 to December 2020, the clinical data of 52 patients who received microsurgical clipping for ruptured via keyhole approach were retrospectively analysed. Forty-one patients had the intraoperative endoscopic monitoring. The supraorbital keyhole approach or pterional keyhole approach was applied based on the characteristics of the aneurysms. According to the in-surgery requirement, a 30° rigid neuroendoscope was used before and/or after clipping. All patients entered postoperative follow-up in outpatient clinic and were evaluated with the modified Rankin Scale(mRS).Results:All 52 patients had 52 ruptured PCoA aneurysms. Eighteen of the patients were treated via supraorbital keyhole approach and 34 via pterion keyhole approach. Pre-and post-clipping endoscopic observation were carried out in 12 cases and 29 only with post-clipping endoscopic observation. Residual aneurysmal neck was detected in 3 patients. Missed clipping of perforators was found in 2 patients and followed by proper adjustment of clips. All patients received follow-up angiographic examinations. Total obliteration of the aneurysm and an intact of internal carotid artery and PCoA were found in 41 patients by the intraoperative endoscopic observation. Two residual aneurysmal neck were detected in 11 patients without intraoperative endoscopic observation. After 11 to 45 months of follow-up, all patients had good recovery(mRS 0-1).Conclusion:It is a safe and effective method with endoscopic observation during microsurgical clipping procedure for ruptured PCoA aneurysms via keyhole approaches. It can effectively make up for the insufficient visual angle of microscope, realise the anatomical relationship between the aneurysm and adjacent structures, and avoid residual aneurysmal neck and an iatrogenic injury to the parent artery and perforators.

Efficacy of modified posterior fossa decompression in the treatment of Chiari type Ⅰ malformation with the neuroendoscope / 西安交通大学学报(医学版)

【Objective】 To investigate the clinical efficacy of modified posterior fossa decompression in treating Chiari type I malformation under the neuroendoscope. 【Methods】 We made a retrospective analysis of the clinical data of 63 patients with Chiari type I malformation treated at the Neurosurgery Department of The First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to December 2019. Of the patients, 28 ones underwent modified posterior fossa decompression assisted with neuroendoscopy (observation group) while 35 received posterior fossa decompression with duraplasty (control group). Tator grading, syringomyelia improvement and complications were compared between the two groups to evaluate the postoperative efficacy. 【Results】 The operations were successful in all the 63 patients and no death or severe neurological dysfunction was observed. The efficacy rate was 78.6% in the observation group and 54.3% in the control group, with significant difference (P0.05). 【Conclusion】 Modified posterior fossa decompression assisted with neuroendoscope is a safe and effective treatment for Chiari type Ⅰ malformation. Intraoperative dural watertight suture and dural-muscle suspension can help reduce the occurrence of subcutaneous effusion.

Pineal gland tumor resection via supracerebellar infratentorial approach under neuroendoscope: a clinical analysis of four cases / 中华神经医学杂志

Objective:To investigate the clinical effacies of endoscopic midline and paramedian supracerebellar infratentorial (SCIT) approaches during resection of pineal tumors.Methods:The clinical data of 4 patients with pineal tumors resected via SCIT approach under neuroendoscope in our hospital from December 2017 to March 2019 were analyzed retrospectively. All patients underwent MR imaging plain and enhanced scans before operation. The tumors were resected via SCIT approach under general anesthesia in lateral subduction position (three were via paramedian SCIT approach and one was via midline SCIT approach). The patients were followed up for 3-12 months and the brain MR imaging was reexamined.Results:The tumors were completely resected in 4 patients. Two patients were confirmed to have mixed germ cell tumors, one was confirmed to have seminoma, and the other one was confirmed to have mature teratoma by postoperative pathology. One achieved good recovery after surgery. Two were treated with whole brain and spinal cord radiotherapy, the original lesion in one patient recurred 4 months after resection and systemic chemotherapy was given, and so far, no recurrence was noted; and the other one achieved good recovery. One did not receive chemoradiotherapy due to economic reasons and relapsed 4 months after surgery.Conclusion:It is safe and effective to resect the tumors in pineal region via midline and paramedian SCIT approaches with neuroendoscopy; the best approach should be selected according to the blood supply, size and location of the lesions.

Role of high sensitivity C- reactive protein as a marker of inflammation and its prognostic significance in chronic kidney disease patients

Background: Chronic kidney disease (CKD) is a clinical syndrome due to irreversible renal dysfunction leading to excretory, metabolic and synthetic failure culminating into accumulation of non-protein nitrogenous substances and present with various clinical manifestations. Elevated circulating concentrations of CRP are a common phenomenon in ESRD patients. The prevalence and magnitude of inflammation increases as renal function declines.Methods: The current cross-sectional observation study was conducted in Rajendra institute of medical sciences, Ranchi during study period October 2015 to September 2017 on admitted patients with chronic kidney disease. 90 patients of different age groups between 16-75 years were enrolled in the study. Samples were selected by using simple random sampling method. Informed consent was obtained from all the patients.Results: 85.6% of the patients studied were males and 14.4% of the patients were females. Most cases of CKD were associated with hypertension (77.8%) out of which there were 62 males and 8 females, followed by DM (25.5%) where there were 20 males and 3 females. 44.4% cases had an elevated level of hs-CRP (more than 3 mg/L) while 55.6% patients had hs-CRP below 3 mg/l. Out of 40 high hs-CRP patients, 35 were male and 5 were female. Patients with elevated creatinine level had significant high hs-CRP level.Conclusions: Chronic kidney diseases, Cardiovascular disease, HS-CRP, Inflammation

Construction and application of 3D printing model of endoscopic endonasal transsphenoidal surgical training / 中国神经精神疾病杂志

Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.

Clinical effect of navigation assisted neuroendoscope hard channel technology with the assistance for treating hypertensive cerebral hemorrhage in basal ganglia region / 重庆医学

Objective To investigate the effect of navigation assisted neuroendoscope hard channel technology for treating hypertensive cerebral hemorrhage in basal ganglia region.Methods Eighty-two inpatients with hypertensive cerebral hemorrhage in basal ganglia region treated in this hospital were selected as the study subjects,among them 37 cases adopted the neuroendoscope hard channel technology and 45 cases adopted the small bone window craniotomy.The operation time,intraoperative bleeding vol-ume,hematoma clearance rate,postoperative complication occurrence rate and NIHSS score at postoperative 3 months were com-pared between the two groups.Results Compared with the bone window group,the operative time in the endoscopic group was lon-ger and the hematoma clearance rate was higher,intracranial rebleeding occurrence rate was lower and the short term prognosis was better(P<0.05).The aspects of intraoperative bleeding volume and other postoperative complications had no statistically signifi-cant difference between the two groups(P> 0.05).Conclusion The navigation assisted neuroendoscope hard channel technology can improve the cure rate in the patients with hypertensive cerebral hemorrhage in basal ganglia region.

Lateral skull base surgical approach and neuroendoscope in lateral skull base surgery / 中华神经医学杂志

Due to the deep anatomical location which is adjacent to the important organization, the operation on the diseases of lateral skull base area is still a challenging problem for neurosurgeons. This article briefly describes the history of the lateral skull base surgical approaches, advantages and disadvantages of each approach, indication and relative contraindication, and enumerates the application of neuroendoscope in the corresponding area, so as to offer help to choose the appropriate surgical approach according to the clinical characteristics; the application prospect of neuroendoscope in the relevant regions is discussed.

Endoscopic Treatment of an Adult with Tegmental Astrocytoma Accompanied by Cerebrospinal Fluid Dissemination

Midbrain gliomas are relatively rare neoplasms with a generally benign prognosis, with dissemination or metastasis not previously reported. We describe here a woman, in whom magnetic resonance imaging scans showed hydrocephalus and a tegmental lesion in the upper aqueduct. Endoscopic third ventriculostomy and biopsy were performed; during surgery, a second small lesion was observed in the infundibular recess. Histologically, the two lesions had the characteristics of low grade astrocytoma, suggesting that the midbrain astrocytoma may have been disseminated via the cerebral spinal fluid to the infundibular recess. Postoperatively this patient received radiotherapy for nearly one month. Although patients with these tumors are not usually administered adjunctive therapy, radiation and, combined modality therapy, including surgery, radiotherapy, and chemotherapy, may be beneficial in patients with midbrain gliomas with dissemination.

From Exoscope into the Next Generation

An exoscope, high-definition video telescope operating monitor system to perform microsurgery has recently been proposed an alternative to the operating microscope. It enables surgeons to complete the operation assistance by visualizing magnified images on a display. The strong points of exoscope are the wide field of view and deep focus. It minimized the need for repositioning and refocusing during the procedure. On the other hand, limitation of magnifying object was an emphasizing weak point. The procedures are performed under 2D motion images with a visual perception through dynamic cue and stereoscopically viewing corresponding to the motion parallax. Nevertheless, stereopsis is required to improve hand and eye coordination for high precision works. Consequently novel 3D high-definition operating scopes with various mechanical designs have been developed according to recent high-tech innovations in a digital surgical technology. It will set the stage for the next generation in digital image based neurosurgery.

Anatomic Structural Study of Internal Auditory Artery via Neuroendoscope / 听力学及言语疾病杂志

Objective To study the anatomic characteristics and clinical values of the internal auditory artery via the neuroendoscope and microscope.Methods We observed the related microdissection of the internal auditory artery of 15 cadavers through retrosigmoid approach by operative microscope and neuroendoscope,in which 3 cadavers were fresh.Results The internal auditory arteries were observed bilaterally in all specimens (100％).Among them,17 sides (56.7％,17/30) were isolated branch type,9 sides were dual trunk (30％,9/30),and 4 sides were three branches type (13.3％,4/30).The diameter of the vessel at its origin was 0.12～0.28 mm,the average caliber of IAA was 0.22±0.04 mm,the length of IAA ranged from 7.12 to 14.82 mm,and the Mean 10.18± 2.63 mm.The starting-point of IAA was quite variable,13.3％ (4/30) of the IAA origined from the inferior segment of the basilar artery,and 86.7 ％(26/30) of the IAA origined from ACIA.Among them,17 sides (65.4％,17/26) of the IAA origined from the ansa of the inferior cerebellar artery,9 sides (34.6％,9/26) of the IAA origined from the anterior inferior cerebellar artery involved in the inner ear canal.We observed that 73.3 ％(22/30) of the IAA branches were along the ventral side of the vestibulocochlear nerve;26.7 ％(8/30) of the IAA branches were above the nerves.It's easy to identify the IAA and its adjacent structures by various neuroendoscope through various anatomic fissures.Conclusion Most of internal auditory arterys were located anterior and posterior to the facial nerve,the microscope was impossible to see it directly.A thorough identification of the internal auditory artery requires theuse of both surgical microscopy and neuroendoscope.

Comparison of neuroendoscopic and microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels / 中国内镜杂志

Objective To compare the efficacy of neuroendoscopic vs microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels and clinical symptoms. Methods A retrospective analysis was conducted on 211 cases with pituitary tumor resection patients from January 2012 to June 2016, of which 112 cases with endoscopic endonasal transsphenoidal pituitary tumor resection (group A), 99 cases with microscopic transsphenoidal pituitary tumor resection (group B), and operation related indexes, hormone variations before discharge and symptoms remission 24 weeks after operation were extracted and compared. Results Two groups of patients with different tumor resection extent (Z = 2.14, P = 0.032), group A achieved total resection rate was significantly higher than the group B (79.5% vs 67.7%) (P = 0.037); the operation time of group A was significantly longer than group B [(93.6 ± 26.7) vs (79.8 ± 20.2) min, t = 4.26, P = 0.000], group A with the mean hospitalization stay was significantly less than group B [(7.9 ± 2.5) vs (10.2 ± 4.3) d, t = 4.67, P = 0.000], postoperative complications of group A were significantly lower than those of group B (5.4% vs 14.1%, χ2 = 4.73, P = 0.030). Two groups of postoperative hormone levels decreased in different degree (Z = 2.42, P = 0.016), group A with hormone recovery rate before discharge was significantly higher than group B (82.2% vs 66.7%, χ2 = 6.09, P = 0.014), and decline on prolactinomas, ACTH adenoma, ghrelin hormone were significantly higher than group B [(43.2 ± 10.5) vs (33.5 ± 9.1) ng/ml, (26.0 ± 8.8) vs (20.2 ± 7.0) pmol/L, (11.0 ± 3.9) vs (8.7 ± 3.2) μg/L, t = 3.60, t = 2.65, t = 2.12, all P < 0.05]. There was no significant differences between the two groups in remission of clinical symptoms 24 weeks after operation (P > 0.05). Conclusion Neuroendoscopic endonasal transsphenoidal pituitary adenoma resection is more efficient and less operative complications compared with microscopic surgery, which is more conducive to the recovery of postoperative hormone levels.

Clinical efficacy of surgery for chronic subdural hematoma assisted by rigid neuroendoscope / 中国内镜杂志

Objective To discuss the clinical efficacy of surgery for chronic subdural hematoma assisted by rigid neuroendoscope and its surgical techniques. Methods Clinical data of 161 patients with chronic subdural hematoma from August 2009 to December 2015 was analyzed retrospectively. 74 of them experienced surgeries assisted by rigid neuroendoscope (endoscope group) and other 87 cases were operated without neuroendoscope (routine group) during the same period. Results Although there were significant difference in operative duration between the two groups, complications, ratio of total removal of hematoma after surgery, postoperative inpatient duration and recurrent rate of hematoma were more advantageous in endoscope group. The operative duration of endoscope group with (112.68 ± 34.86) min was longer than that of routine group with (74.11 ± 28.23) min (t = 7.75, P = 0.000), while the postoperative inpatient duration of endoscope group with (8.23 ± 2.01) d was shorter than that of another group with (10.79 ± 5.02) d (t = -4.12, P = 0.000). There were no surgical associated complications in endoscope group, but 1 patient in routine group experienced intracerebral hematoma of frontal lobe and associated aphemia. Total removal of hematoma was confirmed in endoscope group with 98.65% (73/74), which was higher than that in routine group with 86.21% (75/78) (χ2 = 8.34, P = 0.004). Hematoma recurrence was found in 16 cases of routine group (18.39%), but more superiority in endoscope group with 1.35% (χ2 = 12.29, P = 0.000). Outpatient follow-up was carried out in all patients from 6 to 38 months with an average duration of 30.06 months. In 17 cases with recurrent hematoma during follow-up, 15 of them were cured by a second surgery, and another 2 patients were cured by atorvastatin. Conclusion As a simple, safe and effective technique, the application of rigid neuroendoscope during surgery for chronic subdural hematoma is more advantage than routine surgery. A self-made suction with adjustable soft curved tip is suitable for such procedure.

Clinical study of transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection / 中国医师进修杂志

Objective To explore the surgical techniques of transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection. Methods The clinical data of 71 patients who had underwent transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection were retrospectively analyzed. Results Among the 71 patients, pituitary tumors was in 67 cases (including recurrent pituitary tumors 4 cases), and Rathke cysts in 4 cases. A total of 54 cases had gross total resection, 10 cases had near total resection, and 7 cases had subtotal resection. Some patients had postoperative complications, including transient diabetes insipidus in 16 cases, refractory hyponatremia in 2 cases,cerebrospinal rhinorrhea in 1 case,hypothyroidism in 1 case,rhinorrhagia and synechia nasal in 1 case, hyposmia in 4 cases, and perioperative cerebral infarction in 1 case. There was no surgery related death. After 3 months' follow- up, 12 cases were found to have nasal mucosa atrophy. Conclusions The transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection is safe and effective, with less serious complications, but the complications of nasal cavity should not be ignored.

Advantages of surgical treatment aided by neuroendoscopy for massive intracerebral hemorrhage breaking into ventricle / 中华神经医学杂志

Objective To explore the advantages of neuroendoscope assisted surgery for cerebral hemorrhage breaking into ventricles.Methods Fifty patients with cerebral hemorrhage breaking into ventricles,admitted to our hospital from January 2013 and December 2016,were retrospectively studied;25 patients in observation group were performed evacuation of brain parenchyma and intraventricular hematoma under neuroendoscope and intubation draina,while 25 patients in control group were performed intraventricular drainage and evacuation of hematoma under microscope.Time of carrying tube,intracranial infection rate,intraventricular hematoma clearance rate,and Glasgow coma scale (GCS) scores were analyzed in the two groups.Results The patients from the observation group had shorter time of carrying tube ([4.0±1.9] d),lower intracranial infection rate (12％),and higher GCS scores 7 d after operation (11.1±2.3) than patients from the control group ([7.0±2.1) d,36％,9.0±2.8) with statistical differences (P＜0.05).The intraventricular hematoma clearance rate in the observation group on the 1st,3rd and 7rd d of operation (60.12％±10.23％,70.75％±17.21％,83.36％±8.64％) was significantly higher than that in the control group (25.35％±11.35％,50.48％±13.90％,65.75％±9.32％,P＜0.05).Conclusion The surgical treatment aided by ventriculoscope for intracerebral hemorrhage breaking into ventricle has advantages in shortening the extubation time,reducing the incidence of infection and improving the prognosis.

Neuronavigation assisted endoscopic surgery of hypertensive intracerebral hemorrhage / 中华神经医学杂志

Objective To explore the clinical effect of neuronavigation assisted endoscopic surgery in treatment of patients with hypertensive intracerebral hemorrhage. Methods Fifty patients with hypertensive cerebral hemorrhage, admitted to our hospital from June 2014 to June 2016, were selected. All patients were treated with neuronavigation guided endoscopic surgery. Their clinical data and surgical efficacies were retrospectively analyzed. Results Patients' head CT was reviewed 6 h after operation, and residual hematoma volume was less than 15％among 31 patients, and in the ranges of 15％-30％among 14 patients. Re-bleeding occurred in 4 patients, and death in one patient. Glasgow outcome scale (GOS) of 49 patients 6 months after operation indicated vegetative state in 5 patients, severe disability in 9, moderate disability in 10, and good recovery in 25. Conclusion Neuronavigation assisted endoscopic surgery has good clinical effect on patients with hypertensive intracerebral hemorrhage in terms of few complications and high safety, so it is worthy of promotion and application in clinical practice.

Comparison of efficacy and economic efficiency of neuroendoscope versus microscope for intracerebral hemorrhage / 实用医学杂志

Objective To investigate the differences of efficacy and economic efficiency between neuroendoscope and microscope for intracerebral hematomas cleaning operation. Methods From August 2014 to August 2015, clinical data of 68 cases with intracerebral hemorrhage were analyzed retrospectively. Hematoma evacuation was carried out by microscope in 37 cases (microscope group) received and 31 cases (endoscope group) underwent neuroendoscope. Following parameters were compared: the operation related index (hematoma clearance rate , intraoperative blood loss , the operation time , skin incision , bone window size ) , Glasgow Outcome Scale at 6 months after the operation, complications (intracranial infection, lung infections, gastrointestinal bleeding), medical economic parameters (the postoperative hospital stay, drug cost, cost other than drug, and total hospital cost). Results The hematoma clearance rate, Glasgow Outcome Scale at 6 months after the operation in the endoscope group were significantly better than those in the microscope group (P 0.05). The postoperative hospital stay, drug costs , no drug costs , and total hospital cost were significantly less in neuroendoscope group than that in microscope group (P< 0.01). Conclusion Neuroendoscopy has less trauma,there are some advantages of neuroendoscopy for intracerebral hematomas cleaning operation , such as minimal trauma , prominent effect , good prognosis and low cost. It should be widely applied in clinical practice.

Multifunctional curve and detachable suction and stripping tubes with electrical coagulation in neuroendoscope assisted pituitary tumor resection through endonasal transsphenoidal pathway / 中华神经医学杂志

Objective To develop multi-functional suction tubes used in neuroendoscope assisted pituitary tumor surgery via endonasal transsphenoidal pathway and investigate their application value.Methods The experiments included 145 pituitary tumor patients,recruited in our hospital from March 2014 to March 2015.Self-regulating multi-functional curve and detachable suction tubes were used in neuroendoscope assisted pituitary tumor resection,which could do suction,electrical coagulation and stripping together.The efficacy of them was analyzed.Results There were 101 total tumor resection,26 subtotal resection and 18 partial resection in the 145 pituitary tumor patients.The average operative blood loss was 41.52 mL with application of the multifunctional suction tubes.The shortest time in operation was 28 min,and the average operation time was 76.55 min.Patients were discharged 3-5 days after surgery and the prognosis were good.Conclusion As a safe and effective novel endoscopic neurosurgery instrument,the multifunctional curve and detachable suction and stripping tubes with electrical coagulation could significantly improve surgery effectiveness and reduce operative blood loss when used in pituitary tumor resection through endonasal transsphenoidal pathway.

Clinical evaluation of neuroendoscopic treatment in intraventricular infection with hydrocephalus：an analysis of 27 cases / 中华神经医学杂志

Objective To present our experiences of treatment of intraventricular infection complicated with hydrocephalus by neuroendoscopic approach. Methods A retrospective review of clinical data of 27 patients with severe intraventricular infection complicated with hydrocephalus treated under neuroendoscope at our hospitals from January 2011 and December 2014 was performed. All patients were diagnosed by clinical menifestations and cerebrospinal fluid (CSF) analysis, and operations including ventricular drainage, eliminate intraventricular pus, third ventriculostomy and septostomy were done by one senior surgeon. The neuroendoscopic techniques and clinical outcomes were analyzed. Results Preoperative cerebrospinal fluid analysis in all patients presented with decreased glucose level and increased white cell counts up to 1 500 ×106/L. Cerebrospinal fluid glucose levels of 23 patients (85.2%) were higher than 3 mmol/L (reference value: 2.5-4.5 mmol/L) and body temperature of 22 patients (81.4%) returned to normal level in one week after surgery; 24 patients (88.9%) showed improvement in hydrocephalus; death was noted in one patient (0.04% ). Conclusions Neuroendoscopy has great advantage of broad vision. Intraventricular structure and pathology can be clearly observed with neuroendoscopy. Our experience in treating intraventricular infection and hydrocephalus by neuroendoscopic method has great effectiveness.