中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (12): 2095-2103.doi: 10.4103/1673-5374.262591

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

神经外科内镜技术在脑室感染评估和治疗中的应用

  

  • 出版日期:2019-12-15 发布日期:2019-12-15
  • 基金资助:

    首都健康研究发展专项基金（2011-2008-06），首都临床应用研究项目（Z131107002213044），北京医院培养项目（PX2019026）

Application of neuroendoscopic surgical techniques in the assessment and treatment of cerebral ventricular infection

Feng Guan 1 ,Wei-Cheng Peng 1 , Hui Huang 1 , Zu-Yuan Ren 2 , Zhen-Yu Wang 3 , Ji-Di Fu 4 , Ying-Bin Li 5 , Feng-Qi Cui 6 , Bin Dai 1 , Guang-Tong Zhu 1 , Zhi-Yong Xiao 1 , Bei-Bei Mao 1 , Zhi-Qiang Hu 1   

  1. 1 Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
    2 Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
    3 Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
    4 Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
    5 Department of Neurosurgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
    6 Department of Neurosurgery, Beijing Liangxiang Hospital, Beijing, China
  • Online:2019-12-15 Published:2019-12-15
  • Contact: Zhi-Qiang Hu, MD, neuro7777@126.com.
  • Supported by:

    This work was supported by the Capital Health Research and Development of Special Funding Support of China, No. 2011-2008-06 (to ZQH), Capital Characteristic Clinical Application Research of China, No. Z131107002213044 (to ZQH) and Beijing Municipal Administration of Hospitals Incubating Program of China, No. PX2019026 (to FG).

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摘要：

神经外科内镜技术在脑室感染评估和治疗中的应用

脑室感染的死亡率和致残率极高，是神经外科手术中最危险的并发症之一，但很少有研究关注神经外科内镜技术在评估和治疗脑室感染方面的应用。此次多中心回顾性研究收集了来自首都医科大学附属北京世纪潭医院、北京协和医院、北京大学第三医院、首都医科大学附属北京同仁医院、南京医科大学附属第二医院和北京良乡医院6所医院32例使用神经外科内镜技术治疗脑室感染的患者，其中男20例，女12例，平均42.97岁。使用神经外科内镜技术消除脑室内碎片和脓液、开窗或切开脑室间隔，并重建脑脊液循环，去除人工材料。术后应用抗生素盐水进行脑室内冲洗。通过内镜进行第三脑室造瘘或脑室-腹腔分流治疗继发性脑积水。根据神经内镜检查病理学表现将检测结果分为4个等级。32例患者中I级3例、II级13例、III级10例和IV级6例。其中3例I级患者只接受1次神经外科内镜技术，23例II/III级患者接受2次神经外科内镜技术，3例IV级患者接受2次神经外科内镜技术，另3例IV级患者接受3次神经外科内镜技术。神经内镜检查结果分级与神经外科内镜手术次数有关。2例患者死于多器官功能衰竭，另外30例患者完全康复。26例发生继发性脑积水患者中，18例接受了脑室-腹腔分流分流，8例接受了内镜第三脑室造瘘。神经外科内镜治疗6-76个月的随访中未见脑室感染复发。结果显示神经外科内镜手术是治疗脑室感染的一种新方法，且神经内镜检查结果分级可成为脑室感染客观全面的评估指标。试验方案于2019年1月25日由首都医科大学附属北京世纪潭医院伦理审查委员会批准。

orcid: 0000-0002-0061-1296 (Zhi-Qiang Hu)

关键词: 神经外科内镜技术, 手术, 脑室感染, 评价, 治疗, 脑积水, 引流, 神经再生

Abstract:

Cerebral ventricular infection (CVI) is one of the most dangerous complications in neurosurgery because of its high mortality and disability rates. Few studies have examined the application of neuroendoscopic surgical techniques (NESTs) to assess and treat CVI. This multicenter, retrospective study was conducted using clinical data of 32 patients with CVI who were assessed and treated by NESTs in China. The patients included 20 men and 12 women with a mean age of 42.97 years. NESTs were used to obliterate intraventricular debris and pus, fenestrate or incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, and remove artificial material. Intraventricular irrigation with antibiotic saline was applied after neuroendoscopic surgery (NES). Secondary hydrocephalus was treated by endoscopic third ventriculostomy or a ventriculoperitoneal shunt. Neuroendoscopic findings of CVI were used to classify patients into Grade I (n = 3), Grade II (n = 13), Grade III (n = 10), and Grade IV (n = 6) CVI. The three patients with grade I CVI underwent one NES, the 23 patients with grade II/III CVI underwent two NESs, and patients with grade IV CVI underwent two (n = 3) or three (n = 3) NESs. The imaging features and grades of neuroendoscopy results were positively related to the number of neurosurgical endoscopic procedures. Two patients died of multiple organ failure and the other 30 patients fully recovered. Among the 26 patients with secondary hydrocephalus, 18 received ventriculoperitoneal shunt and 8 underwent endoscopic third ventriculostomy. There were no recurrences of CVI during the 6- to 76-month follow-up after NES. Application of NESTs is an innovative method to assess and treat CVI, and its neuroendoscopic classification provides an objective, comprehensive assessment of CVI. The study trial was approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, China.

Key words: nerve regeneration, neuroendoscopy, surgery, cerebral ventricular infection, assessment, treatment, hydrocephalus, irrigation, neural regeneration