CAJ | 학술논문

目的探讨神经内镜在神经外科微创手术中的应用经验与方法. 方法回顾性总结分析自2010年10月至2013年3月苏北人民医院神经外科应用神经内镜下微创治疗的52例颅内疾病患者的手术效果和并发症,其中垂体瘤20例、高血压脑出血20例、血管畸形伴血肿1例、脑外伤颅内血肿2例、胆脂瘤2例、视神经损伤2例、脑脊液鼻漏2例、亚急性有分隔硬膜下血肿1例、蛛网膜囊肿2例. 结果除1例胆脂瘤患者术中出现岩静脉撕裂,术后并发小脑静脉性梗死而预后不良以外,其余患者均恢复良好,其中20例垂体瘤全切15例(75％),术后无脑脊液鼻漏发生;23例颅内血肿中血肿清除满意22例,1例脑外伤后双侧颅内血肿患者术后一侧发生再出血,再行开颅血肿清除后恢复;2例行视神经管减压患者视力明显提高；2例脑脊液鼻漏一次性修复效果良好,未发生颅内感染及复发;2例蛛网膜囊肿术后囊肿缩小,症状消失；1例亚急性有分隔硬膜下血肿患者术后血肿清除满意；1例胆脂瘤患者术后恢复良好,复查MRI示肿瘤近全切除. 结论神经内镜可在经鼻颅底手术、颅内血肿微创手术中发挥其显露范围广、深部照明好、微创高效的优势,取得简单快捷、安全有效的治疗效果.
목적 탐토신경내경재신경외과미창수술중적응용경험여방법. 방법 회고성총결분석자2010년10월지2013년3월소북인민의원신경외과응용신경내경하미창치료적52례로내질병환자적수술효과화병발증,기중수체류20례、고혈압뇌출혈20례、혈관기형반혈종1례、뇌외상로내혈종2례、담지류2례、시신경손상2례、뇌척액비루2례、아급성유분격경막하혈종1례、주망막낭종2례. 결과 제1례담지류환자술중출현암정맥시렬,술후병발소뇌정맥성경사이예후불량이외,기여환자균회복량호,기중20례수체류전절15례(75％),술후무뇌척액비루발생;23례로내혈종중혈종청제만의22례,1례뇌외상후쌍측로내혈종환자술후일측발생재출혈,재행개로혈종청제후회복;2례행시신경관감압환자시력명현제고；2례뇌척액비루일차성수복효과량호,미발생로내감염급복발;2례주망막낭종술후낭종축소,증상소실；1례아급성유분격경막하혈종환자술후혈종청제만의；1례담지류환자술후회복량호,복사MRI시종류근전절제. 결론 신경내경가재경비로저수술、로내혈종미창수술중발휘기현로범위엄、심부조명호、미창고효적우세,취득간단쾌첩、안전유효적치료효과.
Objective To explore the experience and methods of neuro-endoscopy in minimally invasive treating intracranial diseases.Methods The surgery effect and complications of minimally invasive treatment under neuro-endoscopy on 52 patients with intracranial diseases,admitted to our hospital from October 2010 to March 2013,were retrospectively summarized; in these 52 patients,20 had pituitary adenoma,20 had hypertensive intracerebral hemorrhage,1 had intracranial hematoma followed arteriovenous malformation,2 had intracranial hematomas after brain injury,2 had cholesteatoma,2 had optic canal decompression,2 had cerebrospinal fluid rhinorrhea,1 had multi-separated subacute subdural hematoma and the last 2 had arachnoid cyst.Results Except for 1 patient having cholesteatoma appeared bleeding of the petrosalvein intraoperatively,which resulted in cerebellum hemorrhage following postoperative venous hemorrhagic infarction and unfavourable prognosis,the rest of the patients recovered well; in 20 patients having hypophysoma,15 (75％) achieved total resection of the pituitary adenoma,and no postoperative cerebrospinal fluid rhinorrhea occurred; in 23 cases of intracranial hematomas,22 were cleared satisfactorily,and the left one occurred rehemorrhage in one side but craniotomy hematoma removal was successfully performed again.The eyesight of 2 patients with optic canal decompression was improved obviously.The repair effects of 2 patients with cerebrospinal fluid leakage were very good without intracranial infection or recurrence.The 2 patients with arachnoid cyst recovered satisfactorily without other complications.One patient with multi-separated subacute subdural hematoma recovered with hematoma clear postoperative satisfactorily; and one patient with cholesteatoma postoperative recovered satisfactorily with tumor resection.Conclusion Neuro-endoscopy has many advantages such as exposed wide range,good deep lighting,minimally invasive and high efficiency in endoscopic transnasal transsphenoidal skull base surgery and intracranial hematomas removal.