Njira Yosokoneza ya Medical Endoscopy mu Neurosurgery Diagnosis ndi Chithandizo

1, Kusintha kopambana mu chigaza m'munsi ndi opaleshoni ya pituitary chotupa

(1) Opaleshoni ya Neuroendoscopic transnasal transsphenoidal (EEA)

Kusokonezeka kwaukadaulo:

Palibe njira yocheka: Chotsani chotupacho kudzera mumsewu wachilengedwe wamphuno kuti mupewe kugunda kwa minofu yaubongo panthawi ya craniotomy.

4K-3D endoscopic system (monga Storz IMAGE 1 S 3D): Amapereka 16 μ m kuya kwa kuzindikira kwamunda kuti asiyanitse malire a pituitary microadenomas.

Zambiri zachipatala:

(2) Fluorescent navigation endoscope

Chizindikiro cha 5-ALA fulorescent:

Preoperative oral administration of aminolevulinic acid inayambitsa fluorescence yofiira m'maselo otupa (monga Zeiss Pentero 900).

Chiwerengero chonse cha kuchotsedwa kwa glioblastoma chakwera kuchoka pa 36% mpaka 65% (NEJM 2023).

2, Chithandizo chocheperako cha zotupa zam'mitsempha ndi zozama zaubongo

(1) Neuroendoscopic third ventricular fistula (ETV)

Ubwino waukadaulo:

3mm endoscopic single channel puncture yochizira obstructive hydrocephalus.

Kuyerekeza opaleshoni ya ventricular shunt: kupeŵa moyo wonse kudalira shunt, kuchepetsa kuchuluka kwa matenda kuchokera ku 15% mpaka 1%.

Zida zatsopano:

Catheter yosinthika ya baluni: kuwunika kwenikweni kwa kutuluka kwa stoma panthawi ya opaleshoni (monga Neurovent-P).

(2) Endoscopic yothandizira kutulutsa magazi muubongo

Kupambana kwaukadaulo:

Pansi pa zenera la fupa la 2cm, mawonekedwe a endoscopic mwachindunji amagwiritsidwa ntchito kuchotsa hematoma (monga Karl Storz MINOP system).

Chilolezo cha hematoma mu basal ganglia ndi wamkulu kuposa 90%, ndipo kuwongolera kwa postoperative GCS score ndi 40% kuposa kukumba ngalande.

3, Endoscopic kulowererapo kwa matenda a cerebrovascular

(1) Endoscopic yothandizira aneurysm clipping

Zowunikira zaukadaulo:

Yang'anani kumbuyo kwa khosi la chotupacho ndi endoscope ya 30 ° kuti mupewe kudulidwa mwangozi kwa mitsempha ya kholo (monga Olympus NSK-1000).

Mlingo wathunthu wa kutsekeka kwa mitsempha yakumbuyo yamtsempha yolumikizirana yawonjezeka kuchoka pa 75% mpaka 98%.

(2) Endoscopic vascular bypass graft

STA-MCA anastomosis:

2mm Ultra-fine endoscope yothandizira suturing ili ndi chiwonjezeko cha 12% pamlingo wa patency poyerekeza ndi magwiridwe antchito ang'onoang'ono.

4. Chithandizo cholondola mu neurosurgery yogwira ntchito

(1) Endoscopic yothandizira DBS implantation

Zaukadaulo:

Kuwona kwanthawi yeniyeni kwa zolinga (monga STN nuclei), m'malo mwa kutsimikizira kwa MRI.

The electrode offset zolakwa za odwala Parkinson a matenda ndi zosakwana 0.3mm (chikhalidwe chimango opaleshoni pafupifupi 1mm).

(2) Endoscopic decompression kwa trigeminal neuralgia

Microvascular decompression (MVD):

Kupyolera mu njira ya 2cm keyhole, endoscopy inawonetsa mikangano ya mitsempha ya mitsempha, ndipo mphamvu yowonongeka inali 92%.

5, Intelligent ndi Navigation Technology

(1) AR neural navigation endoscope

Kukhazikitsa mwaukadaulo:

Monga Brainlab's Elements AR, data ya DICOM ikuwonetsedwa munthawi yeniyeni kumalo opangira opaleshoni.

Mu opaleshoni ya craniopharyngioma, kulondola kwa kuzindikira kwa phesi la pituitary ndi 100%.

(2) AI intraoperative chenjezo dongosolo

Kuzindikira kwa mitsempha AI:

Monga Surgalign's Holosight, imangodzilemba zokha zotengera zoboola pazithunzi za endoscopic kuti muchepetse kuvulala mwangozi.

(3) Makina ogwiritsira ntchito galasi la robot

Mirror yokhala ndi loboti:

Monga Johnson Medical's NeuroArm, imachotsa kugwedezeka kwa manja kwa dokotala wa opaleshoni ndipo imapereka kukhazikika kwa 20x kwa chithunzicho.

6. Mayendedwe aukadaulo amtsogolo

Endoscope ya molekyulu ya ma cell:

Ma nanoparticles a fluorescent akuloza ma CD133 achitetezo kuti alembe ma cell a glioma stem.

Mankhwala a biodegradable stent amathandizira kupanga fistula:

Magnesium alloy stent imasunga mphamvu ya fistula yachitatu ya ventricle ndipo imatengedwa pakadutsa miyezi 6.

Optogenetic endoscopy:

Kukondoweza kwa kuwala kwa buluu kwa ma neuron osinthidwa ma genetic pochiza khunyu (refractory stage) (gawo loyesera nyama).

Table Yofananira ya Phindu Lachipatala

Malingaliro okhazikitsa njira

Pituitary Tumor Center: Pangani chipinda chopangira opaleshoni cha EEA + intraoperative MRI.

Cerebrovascular disease unit: yokhala ndi endoscope fluorescence angiography three mode system.

Cholinga cha kafukufuku: Kupanga chotchinga chamagazi-muubongo cholowera mkati mwa endoscopic fulorescent probe.

Ukadaulo uwu ukukankhira ma neurosurgery kupita ku nthawi "yosasokoneza" kudzera m'njira zitatu zazikulu: kuwonongeka kwa zero, kulondola kwa millimeter, komanso kuteteza thupi. Zikuyembekezeka kuti pofika chaka cha 2030, 70% ya maopaleshoni a chigaza adzamalizidwa kudzera mu njira zachilengedwe za endoscopic.