目的:精确的计划和执行是神经内镜干预的关键,可能基于不同的辅助技术。这项回顾性研究的目的是报告基于病例的引导神经内窥镜检查的利用,并为可用技术开发分层算法。
方法:我们回顾了2016年至2018年在我们中心进行的连续神经内镜病例。我们区分了接受新毛刺孔的患者(A组)与先前存在毛刺孔的患者(B组)。程序规划和执行的具体案例技术要求,并发症发生率,手术结果,和可能的后续手术进行了评估。根据这一经验,开发了一种分层系统来定制可用的指导技术。
结果:研究中纳入了243例患者的309例神经内镜干预。病例包括脑积水(81.6%)和非脑积水(18.4%)。干预措施得到了基于坐标的支持(CB:A组n=49;B组n=67),基于指南(GB:A组n=42;B组n=0),超声辅助(UG:A组n=50;B组n=7)或增强现实导航(NAR:A组n=85;B组n=9)技术,分别。总并发症发生率为4.5%。根据手术适应症,fontanel状态,入口点本地化,预先存在的毛刺孔,心室大小,和目标数量,建议采用分层的方法进行图像引导的神经内窥镜检查。
结论:规划和技术指导对于神经内镜手术至关重要。针对不同可用技术的分层决策算法旨在实现更低的成本和时间消耗,这是经验丰富的安全和高效。需要进一步的调查才能提供有关程序效率的可靠数据。
Precise planning and execution is key for neuroendoscopic interventions, which can be based on different available aiding technologies. The aim of this retrospective
study is to report a case-based use of guided neuroendoscopy and to develop a stratification algorithm for the available technologies.
We reviewed consecutive neuroendoscopic cases performed at our center from 2016 to 2018. We distinguished between patients receiving a new burr hole (group A) and those with a preexisting burr hole (group B). Case-specific technical requirements for procedure planning and execution, complication rate, surgical outcome, and possible subsequent surgery were evaluated. From this experience, a stratification system was developed to tailor the available guiding technologies.
A total of 309 neuroendoscopic interventions in 243 patients were included in the present
study. The cases included hydrocephalic (81.6%) and nonhydrocephalic (18.4%) conditions. The interventions were supported by coordinate-based (group A, n = 49; group B, n = 67), guide-based (group A, n = 42; group B, n = 0), ultrasound-guided (group A, n = 50; group B, n = 7), or navigated augmented reality-guided (group A, n = 85; group B, n = 9) techniques. The overall complication rate was 4.5%. Stratified by the surgical indication, fontanel status, entry point localization, presence of a preexisting burr hole, ventricular size, and number of targets, an approach toward image-guided neuroendoscopy is suggested.
Planning and technical guidance is essential in neuroendoscopic procedures. The stratified decision-making algorithm for different available technologies aims to achieve lower cost and time consumption, which was found to be safe and efficient. Further investigations are warranted to deliver solid data on procedure efficiency.