Disruptive Solution of Medical Endoscopy in Neurosurgery Diagnosis and Treatment

1、 Revolutionary breakthrough in skull base and pituitary tumor surgery

(1) Neuroendoscopic transnasal transsphenoidal surgery (EEA)

Technological disruption:

No incision approach: Remove the tumor through the natural nasal passage to avoid brain tissue traction during craniotomy.

4K-3D endoscopic system (such as Storz IMAGE 1 S 3D): Provides 16 μ m depth of field perception to distinguish the boundaries of pituitary microadenomas.

Clinical data:

(2) Fluorescent navigation endoscope

5-ALA fluorescent labeling:

Preoperative oral administration of aminolevulinic acid triggered red fluorescence in tumor cells (such as Zeiss Pentero 900).

The total resection rate of glioblastoma has increased from 36% to 65% (NEJM 2023).

2、 Minimally invasive treatment of ventricular and deep brain lesions

(1) Neuroendoscopic third ventricular fistula (ETV)

Technical advantages:

3mm endoscopic single channel puncture for the treatment of obstructive hydrocephalus.

Comparison of ventricular shunt surgery: lifelong avoidance of shunt dependence, reducing infection rate from 15% to 1%.

Innovative equipment:

Adjustable pressure balloon catheter: real-time monitoring of stoma flow during surgery (such as Neurovent-P).

(2) Endoscopic assisted clearance of cerebral hemorrhage

Technological breakthrough:

Under a 2cm bone window, endoscopic direct visualization is used to remove hematoma (such as Karl Storz MINOP system).

The clearance rate of hematoma in the basal ganglia is greater than 90%, and the improvement rate of postoperative GCS score is 40% higher than that of drilling drainage.

3、 Endoscopic intervention for cerebrovascular disease

(1) Endoscopic assisted aneurysm clipping

Technical highlights:

Observe the posterior part of the tumor neck with a 30 ° endoscope to avoid accidental clipping of the parent artery (such as Olympus NSK-1000).

The complete occlusion rate of posterior communicating artery aneurysms has increased from 75% to 98%.

(2) Endoscopic vascular bypass graft

STA-MCA anastomosis:

The 2mm ultra-fine endoscope assisted suturing has a 12% increase in patency rate compared to microscopic operation.

4、 Precision treatment in functional neurosurgery

(1) Endoscopic assisted DBS implantation

Technological innovation:

Real time endoscopic observation of targets (such as STN nuclei), replacing intraoperative MRI verification.

The electrode offset error of Parkinson's disease patients is less than 0.3mm (traditional frame surgery is about 1mm).

(2) Endoscopic decompression for trigeminal neuralgia

Microvascular decompression (MVD):

Through a 2cm keyhole approach, endoscopy showed nerve vessel conflict points, and the effective rate of decompression was 92%.

5、 Intelligent and Navigation Technology

(1) AR neural navigation endoscope

Technical implementation:

Like Brainlab's Elements AR, DICOM data is projected in real-time to the surgical field.

In craniopharyngioma surgery, the accuracy of pituitary stalk recognition is 100%.

(2) AI intraoperative warning system

Vascular recognition AI:

Like Surgalign's Holosight, it automatically marks perforating vessels in endoscopic images to reduce accidental injuries.

(3) Robot mirror holding system

Mirror holding robot:

Like Johnson Medical's NeuroArm, it eliminates hand tremors in the surgeon and provides stable 20x magnification of the image.

6、 Future technological directions

Molecular imaging endoscopy:

Fluorescent nanoparticles targeting CD133 antibodies to label glioma stem cells.

Biodegradable stent assisted fistula creation:

The magnesium alloy stent maintains the patency of the third ventricle fistula and is absorbed after 6 months.

Optogenetic endoscopy:

Blue light stimulation of genetically modified neurons for the treatment of refractory epilepsy (animal experimental stage).

Clinical Benefit Comparison Table

Implementation strategy suggestions

Pituitary Tumor Center: Construct an EEA+intraoperative MRI composite operating room.

Cerebrovascular disease unit: equipped with endoscope fluorescence angiography three mode system.

Research focus: Developing a blood-brain barrier penetrating endoscopic fluorescent probe.

These technologies are pushing neurosurgery towards a "non-invasive" era through three major breakthroughs: zero tensile damage, sub millimeter level precision, and physiological function preservation. It is expected that by 2030, 70% of skull base surgeries will be completed through natural endoscopic procedures.