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首页> 外文期刊>Neurosurgical focus >A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes
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A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes

机译：多端口MR兼容神经内窥镜：跨越刚性和柔性示波器之间的间隙

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OBJECTIVE Rigid endoscopes enable minimally invasive access to the ventricular system; however, the operative field is limited to the instrument tip, necessitating rotation of the entire instrument and causing consequent tissue compression while reaching around corners. Although flexible endoscopes offer tip steerability to address this limitation, they are more difficult to control and provide fewer and smaller working channels. A middle ground between these instruments—a rigid endoscope that possesses multiple instrument ports (for example, one at the tip and one on the side)—is proposed in this article, and a prototype device is evaluated in the context of a third ventricular colloid cyst resection combined with septostomy. METHODS A prototype neuroendoscope was designed and fabricated to include 2 optical ports, one located at the instrument tip and one located laterally. Each optical port includes its own complementary metal-oxide semiconductor (CMOS) chip camera, light-emitting diode (LED) illumination, and working channels. The tip port incorporates a clear silicone optical window that provides 2 additional features. First, for enhanced safety during tool insertion, instruments can be initially seen inside the window before they extend from the scope tip. Second, the compliant tip can be pressed against tissue to enable visualization even in a blood-filled field. These capabilities were tested in fresh porcine brains. The image quality of the multiport endoscope was evaluated using test targets positioned at clinically relevant distances from each imaging port, comparing it with those of clinical rigid and flexible neuroendoscopes. Human cadaver testing was used to demonstrate third ventricular colloid cyst phantom resection through the tip port and a septostomy performed through the lateral port. To extend its utility in the treatment of periventricular tumors using MR-guided laser therapy, the device was designed to be MR compatible. Its functionality and compatibility inside a 3-T clinical scanner were also tested in a brain from a freshly euthanized female pig. RESULTS Testing in porcine brains confirmed the multiport endoscope's ability to visualize tissue in a blood-filled field and to operate inside a 3-T MRI scanner. Cadaver testing confirmed the device's utility in operating through both of its ports and performing combined third ventricular colloid cyst resection and septostomy with an endoscope rotation of less than 5°. CONCLUSIONS The proposed design provides freedom in selecting both the number and orientation of imaging and instrument ports, which can be customized for each ventricular pathological entity. The lightweight, easily manipulated device can provide added steerability while reducing the potential for the serious brain distortion that happens with rigid endoscope navigation. This capability would be particularly valuable in treating hydrocephalus, both primary and secondary (due to tumors, cysts, and so forth). Magnetic resonance compatibility can aid in endoscope-assisted ventricular aqueductal plasty and stenting, the management of multiloculated complex hydrocephalus, and postinflammatory hydrocephalus in which scarring obscures the ventricular anatomy.
机译：目的硬性内窥镜可实现对心室系统的微创治疗。但是，手术区域仅限于器械尖端，因此必须使整个器械旋转，并在到达拐角处时导致组织受压。尽管柔性内窥镜可提供尖端操纵性来解决此限制，但它们更难以控制，并且提供的工作通道越来越少。本文提出了在这些仪器之间的中间立场-一个刚性的内窥镜，它具有多个仪器端口（例如，一个在尖端，一个在侧面），并且在第三种心室胶体的背景下评估了原型设备囊肿切除联合造瘘术。方法设计并制造了一个原型神经内窥镜，它包括2个光学端口，一个位于仪器尖端，另一个位于侧面。每个光端口均包括其自己的互补金属氧化物半导体（CMOS）芯片相机，发光二极管（LED）照明灯和工作通道。尖端端口具有透明的硅树脂光学窗口，可提供2个附加功能。首先，为了提高工具插入期间的安全性，可以在从内窥镜顶端伸出仪器之前先在窗口内看到它们。其次，顺应性尖端可以压在组织上，即使在充满血液的视野中也可以可视化。这些功能已在新鲜的猪脑中进行了测试。使用位于距每个成像端口临床相关距离的测试目标评估多端口内窥镜的图像质量，并将其与临床刚性和柔性神经内窥镜的图像质量进行比较。使用人体尸体测试来证明通过尖端端口进行第三次脑室胶体囊肿体模切除，并通过侧向端口进行隔造口术。为了扩展其在使用MR引导的激光疗法治疗室周肿瘤中的实用性，该设备被设计为与MR兼容。还从刚安乐死的雌性猪的大脑中测试了其在3-T临床扫描仪中的功能和兼容性。结果在猪脑中进行的测试证实了多端口内窥镜能够可视化充满血液的区域中的组织以及在3-T MRI扫描仪内部进行操作的能力。 Cadaver测试证实了该设备可通过两个端口进行操作，并在小于5°的内窥镜下进行第三次脑室胶体囊肿切除和隔膜造口术。结论所提出的设计为选择成像和仪器端口的数量和方向提供了自由，可以针对每个心室病理实体进行定制。轻巧，易于操作的设备可以提供更高的可操纵性，同时减少在硬性内窥镜导航下发生严重脑部变形的可能性。这种功能在治疗原发性和继发性脑积水方面（由于肿瘤，囊肿等）特别有价值。磁共振兼容性可以帮助内窥镜辅助心室导水管成形术和支架置入术，多部位复杂脑积水的治疗以及疤痕使脑室解剖结构模糊的发炎后脑积水。

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