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Arachnoscopy: A special application of spinal intradural endoscopy

机译：蛛网膜内窥镜：脊柱硬膜内镜的特殊应用

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Object: The microsurgical removal of obstructions to CSF flow is the treatment of choice in the surgical management of intradural arachnoid cysts. Cardiac-gated phase-contrast MR imaging is an effective tool for the primary diagnosis and localization of arachnoid cysts. Microsurgery, however, does not lend itself to assessments of further adhesions beyond the borders of the exposed area. The use of a thin endoscope allows surgeons to assess intraoperatively whether the exposure is wide enough. Methods. Between 2006 and 2010, a single neurosurgeon performed 31 consecutive microsurgical procedures with endoscopic assistance in 28 patients with spinal arachnoid adhesions. A MurphyScope endoscope was used for this purpose. The CSF flow was studied before and after surgery in all patients by using phase-contrast MR imaging in the region of the craniocervical junction, the cervical spine, the thoracic spine, and the lumbar spine. Results. In all 31 procedures, CSF flow obstructions were detected at the level identified by phase-contrast MR imaging. In 29 procedures, image quality was sufficient for an inspection of the adjacent subarachnoid space. In 6 cases, the surgeon detected further adhesions that obstructed CSF flow in the adjacent subarachnoid space that were not visualized with the microscope. In all cases, these adhesions were identified and removed during microsurgery. Conclusions. Arachnoscopy is a helpful adjunct to microsurgery and can be performed safely and easily. It allows the surgeon to detect further adhesions in the subarachnoid space that would remain undetected by microscopy alone.
机译：目的：显微手术清除脑脊液流的阻塞是硬脑膜内蛛网膜囊肿手术治疗的首选治疗方法。心脏门控相衬磁共振成像是蛛网膜囊肿的初步诊断和定位的有效工具。但是，显微外科手术不适合评估暴露区域边界以外的进一步粘连。薄型内窥镜的使用允许外科医生在术中评估暴露范围是否足够宽。方法。在2006年至2010年之间，有28位脊柱蛛网膜粘连患者由一名神经外科医师在内窥镜辅助下连续进行了31次显微外科手术。为此，使用了MurphyScope内窥镜。通过使用颅颈交界处，颈椎，胸椎和腰椎区域的相衬MR成像对所有患者在手术前后的脑脊液流量进行了研究。结果。在所有31个程序中，均以相衬MR成像确定的水平检测到CSF血流阻塞。在29个步骤中，图像质量足以检查相邻的蛛网膜下腔。在6例病例中，外科医生检测到进一步的粘连，阻碍了相邻蛛网膜下腔中CSF的流动，而这在显微镜下是看不到的。在所有情况下，这些粘附均在显微外科手术中被识别并去除。结论蛛网镜检查是显微外科手术的有用辅助手段，可以安全，轻松地进行。它允许外科医生检测蛛网膜下腔中的进一步粘连，而仅靠显微镜检查是无法发现的。

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