Neuronavigation endoscopic techniques in the treatment of lateral ventricle arachnoid cyst _87888 by heku

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									?Neuronavigation endoscopic
techniques in the treatment of
lateral ventricle arachnoid cyst

?

Lateral ventricle cysts more rare, much as the natural formation, and
lateral ventricle choroid Plexus, its contents as cerebrospinal
fluid-like liquid. Lateral ventricle cysts more that arachnoid cyst,
other names have choroid Plexus cysts, ependymal cyst, cyst of glioma.
                                   Shanghai Huashan hospital
neurosurgery Wang Yong Fei

Figure 1 the left ventricle in the triangle area of cyst figure 2
neuronavigation endoscopic showed cysts

Lateral ventricle congenital cyst of onset age not more than 40 years,
to young adults. Cysts occur in the lateral ventricles triangle
district, occipital Horn and temporal Horn, especially before their
majority, and the distribution of choroid Plexus of anatomy. MRI is
the lateral ventricle cysts mainly Imaging diagnosis method (Figure
1), T1-weighted phase low signal on the cyst, and is the same, the
wall of cerebrospinal fluid. Triangle area in the lateral ventricle
or occipital Horn more solid class circle or oval. T2-weighted phase
cyst contents is high signal, the signal of the cyst wall leads the
cyst contents and cerebrospinal fluid, so the display is clear. Water
suppression phase you can use the entire cysts form complete crime.
Cyst in the lateral ventricles in operations and the triangular area
of the choroid Plexus, MRI enhanced visible enhancement in the
choroid Plexus creeping line section of the cyst wall surface.

Symptomatic intracerebroventricular arachnoid cysts mainly with
intracranial hypertension, cerebral oppression and stimulate the
symptoms, need for surgery. Treatment options include: 1. cyst
puncture; 2. cyst peritoneal shunt; 3. cysts in incising; 4. cyst
excision. Cyst puncture recurrence rate is high, is not used. Cyst-
peritoneal shunt surgery more simple, application of the broader,
long-term foreign body implants and shunt plug has been the patients
concerned. Lateral ventricle of choroid Plexus cysts and choroid ball
ties with neighbouring ependymomas and septum pellucidum and surface
vein has adhesion, traditional surgery for cyst excision, not only on
the surgical approach, and trauma surgery microscope on the deep
structure of the exposed the limitations that exist in many surgical
complications, so much heavier. In recent years more inclined to
think that modern Endoscopic Sinus surgery, endoscopic operation with
image clarity, and color reproduction and high, surgery, topographic
detail is good, relevant design fine surgical instruments and many
other advantages, can guarantee the good results of operations, will
minimize surgical trauma. Cysts are usually occupy the lateral
ventricle body, Triangle area and most of the occipital Horn cyst
wall space, close to the surrounding brain structure, endoscope into
the ventricle point should be between the cyst to leave enough space
for intraventricular endoscopy for observation of the cyst and the
adjacent structure, fully estimate operation difficulty, select
rational operation scheme. Cyst wall and choroid Plexus, ependymoma,
transparent spacer and surface vein (especially after intravenous and
Qiu sharp vein), dome, and other important structural adhesive,
adhesive separation easier ependymoma, choroid Plexus adhesive is
usually more closely, separation difficulties regons subtotal, avoid
unpredictable neural-vascular injury.

At present, many domestic and foreign performer adopts incision
method, cysts that incision, cyst recurrence rate is low, and
surgical bleeding risk is extremely small, high safety factor. Cyst
in incising surgical incision of cysts include surgery, Stereotactic
surgery, endoscopic cyst membrane fenestration and neural membrane
assisted endoscopic fenestration. Stereotactic cyst in incising
surgery although accurate design of incision and surgical approaches
to avoid surgery path of brain function is missing, but still a lot
of blindness, easily cause damage to nerves and blood vessels. The
author used endoscopic surgical methods, combined with
neuronavigation assistive technology, successful treatment of the 21
cases of lateral ventricle Cyst (Figure 2). Neuronavigation role
advantage manifests in several ways: 1. in rigorous design approach
and operative trajectory, which enables cortical incision from
functional area, and the endoscopic surgery before and after running
through the trajectory to for easy wall cysts as necessary at the
same time as the cyst fenestration and rear wall; 2. endoscopic
surgical needs to brain indoor shijiankong, veins, Qiu sharp vein,
choroid Plexus and trend, septum pellucidum structure as a reference
mark, prevent surgery to get lost. But brain cyst often leads to the
interior structure of the shift, or film cover on it. Navigate
through neural Imaging Anatomy of precise positioning and improves
the security of the operation, avoid damage important neural-vascular;
3. the complete navigation after registration and calibration steps,
endoscopic work sheath head-end and sheath rod on behalf of the
anchor point and direction, and take advantage of real-time,
interactive operation workstations features that allow the performer
to easily know internal lens-end "where" and "endoscopic work points
to where the sheath. Cyst wall fenestration parts of multiple
selection in a location far away from the choroid Plexus, choroid
Plexus nearby wall surface vein more intensive. Fenestration
instruments and methods in order to: electrocoagulation Cauterization
wall, balloon puncture expansion and micro-cut apart from the wall.
Fenestration area should be at least 20mmq0mm, to prevent the cyst
fenestration edge closed, open the window back to normal bipolar
electrocoagulation window edge. As a single window to open the window
smaller, or cysts and lateral ventricles conglutination surface is
large, may contain choroid Plexus of the lateral ventricle part is
isolated, and cysts shijiankong not traffic, you should be on the
side walls and Windows.

The author believes, neuro-navigation-assisted endoscopic film
fenestration is currently treating brain cysts more reasonable, a
high security operative surgical methods, simple, minimal trauma,
short hospital stay. The follow-up of the patients symptoms clearly
improved, no case of cysts recur.




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