醫(yī)學(xué)研究生課件-現(xiàn)代神經(jīng)外科進(jìn)展-微創(chuàng)神經(jīng)外科(精簡版)雙語

1、現(xiàn)代神經(jīng)外科進(jìn)展微創(chuàng)神經(jīng)外科概述（The Progress of Modern Neurosurgery Summary of Minimally Invasive Neurosurgery )現(xiàn)代神經(jīng)外科進(jìn)展微創(chuàng)神經(jīng)外科概述（The Progre神經(jīng)外科學(xué)是醫(yī)學(xué)中最年輕而又最復(fù)雜的一門分支。自十九世紀(jì)歐洲首先創(chuàng)建神經(jīng)外科專業(yè)以來，新的技術(shù)、治療檢查手段層出不窮，也使得神經(jīng)外科成為臨床醫(yī)學(xué)領(lǐng)域中發(fā)展最快的分支學(xué)科之一。Neurosurgery is the youngest but the most sophisticated branch of medicine. Since Europe

2、first established the major of neurosurgery in the 19th century, with the update of medical technologies, examinations and treatments, neurosurgery has become one of the fastest growing subject of clinical medicine)神經(jīng)外科學(xué)是醫(yī)學(xué)中最年輕而又最復(fù)雜的一門分支。自十九世紀(jì)歐洲1968年，以瑞士學(xué)者 Yasargil為代表的神經(jīng)外科學(xué)家首先開展在顯微鏡下進(jìn)行手術(shù)操作，由于手術(shù)視野放大及

3、良好的照明，使得手術(shù)精確性大為提高，臨近組織的損害機(jī)會(huì)明顯減少，宣告了顯微神經(jīng)外科時(shí)代的到來。In 1968, Swiss neurosurgeons, represented by Yasargil, first carried out the microscopic surgery in neurosurgery. Microscopic surgery, compared with conventional surgery, contributes significantly to the amplification of visual operative field and favor

4、able lighting. These advantages make fine manipulation easier so that the risk of the damage to the surrounding structures decreased. The application of microscopy marked the beginning of the era of microneurosurgery1968年，以瑞士學(xué)者 Yasargil為代表的神經(jīng)外科學(xué)家許多原來不能做的手術(shù)如今成為現(xiàn)實(shí)，原來的手術(shù)禁區(qū)正逐步打破。腦深部病變，腦干腫瘤，脊髓髓內(nèi)腫瘤等許多疑難病癥

5、，前人束手無策，如今在顯微神經(jīng)外科時(shí)代許多問題得到了解決，確實(shí)是神經(jīng)外科治療史上的一項(xiàng)重大技術(shù)革命。The operations used to be impossible become reality now. Some of the operation areas that were inaccessible are no more restricted. Some difficult problems such as brain deep lesions, brain stem neoplasms and intramedullary spinal cord neoplasms whic

6、h were incurable in the past are gradually solved in the new times of microneurosurgery許多原來不能做的手術(shù)如今成為現(xiàn)實(shí)，原來的手術(shù)禁區(qū)正逐步打破。經(jīng)過幾代神經(jīng)外科人的努力，目前神經(jīng)外科已由顯微神經(jīng)外科發(fā)展到微創(chuàng)神經(jīng)外科學(xué)階段。(Through the efforts made by generations of neurosurgeons, neurosurgery has developed from microneurosurgery stage to minimally invasive neuros

7、urgery stage)微創(chuàng)神經(jīng)外科是以最小創(chuàng)傷的操作、最大限度保護(hù)、恢復(fù)腦神經(jīng)功能、最大限度地為病人解決病痛，盡量減少醫(yī)源性損傷。代表了以人為本的人文主義文化，是“生物-心理-社會(huì)”新型醫(yī)療模式的一種表現(xiàn)。(The aims of minimally invasive neurosurgery are to achieve the best possible operative result, patient satisfaction, and minimal operation-related harm. It represents the “patient first” princip

8、le, and is a presentation of biology-psychology-society medical pattern) 經(jīng)過幾代神經(jīng)外科人的努力，目前神經(jīng)外科已由顯微神經(jīng)外科發(fā)展到當(dāng)代神經(jīng)外科要求治療結(jié)果不只是預(yù)防和降低手術(shù)后并發(fā)癥，還包括解剖復(fù)位，以及盡量恢復(fù)病人的神經(jīng)和心理功能。 (The therapeutic results requested now are not only prevention and decrease of surgical complications, but also the maximal recovery of neurolog

9、ic and psychological functions)微創(chuàng)神經(jīng)外科學(xué)是全部外科治療活動(dòng)中追求的目標(biāo)，而不局限于某種治療方法、某種手術(shù)方式或應(yīng)用了某種手術(shù)工具，微創(chuàng)神經(jīng)外科的的概念應(yīng)該貫穿整個(gè)醫(yī)療活動(dòng)中，包括神經(jīng)外科手術(shù)的每個(gè)步驟，如術(shù)前、術(shù)中以及術(shù)后過程。 (The concept of minimally invasion is pursued in all medical activities and surgical procedures, not confined to a therapeutic method, a specific surgical option or a

10、operative tool)當(dāng)代神經(jīng)外科要求治療結(jié)果不只是預(yù)防和降低手術(shù)后并發(fā)癥，還包括微創(chuàng)神經(jīng)外科產(chǎn)生的學(xué)科背景：神經(jīng)影像學(xué)的發(fā)展(Facilitating Conditions：the development of neuroimaging )隨著影像學(xué)的發(fā)展包括頭顱CT、MRI、DSA、PET等診斷手段的更新，對(duì)于神經(jīng)系統(tǒng)病變及周圍正常組織結(jié)構(gòu)提供了詳盡的解剖學(xué)資料，使神經(jīng)外科醫(yī)師對(duì)病灶作出定位診斷和大多數(shù)病變作出病理性診斷使每個(gè)病人術(shù)前治療計(jì)劃更加完善，為神經(jīng)外科手術(shù)提出了更高的要求。 (Owing to the development of imaging tests includ

11、ing head CT, MRI, DSA, PET etc, more information about lesions and normal brain tissue can be acquired that helps neurosurgeons to make location diagnosis even pathological diagnosis of lesions. It actually assists in the planning of therapeutic strategies before an operation. The development of neu

12、roimaging leads to higher standards of neurosurgery)微創(chuàng)神經(jīng)外科產(chǎn)生的學(xué)科背景：神經(jīng)影像學(xué)的發(fā)展(Facilit手術(shù)顯微鏡、神經(jīng)導(dǎo)航、神經(jīng)內(nèi)鏡、各種精巧的手術(shù)器械的不斷涌現(xiàn)，以及顯微外科手術(shù)技術(shù)的熟練運(yùn)用，將顯微神經(jīng)外科提高到新的水平。 a. Microscopy, neuronavigation, neuroendoscopy and all kinds of sophisticated surgical instruments update frequently. b. Neurosurgeons progressively improv

13、e the skill of microsurgery. c. Microneurosurgery has reached to a new level.微創(chuàng)神經(jīng)外科產(chǎn)生的學(xué)科背景：各種神經(jīng)外科器械的發(fā)展(Facilitating Conditions：the development of surgical instruments) 手術(shù)顯微鏡、神經(jīng)導(dǎo)航、神經(jīng)內(nèi)鏡、各種精巧的手術(shù)器械的不斷涌現(xiàn)微創(chuàng)神經(jīng)外科產(chǎn)生的學(xué)科背景：各種神經(jīng)外科器械的發(fā)展(Facilitating Conditions：the development of surgical instruments) 時(shí)代不斷的進(jìn)步，病人更

14、高的要求，更新科學(xué)技術(shù)成果的支持，推動(dòng)醫(yī)學(xué)飛速發(fā)展，作為微創(chuàng)外科領(lǐng)域的一個(gè)分支，微創(chuàng)神經(jīng)外科學(xué)應(yīng)運(yùn)而生。它包括各類新興的微創(chuàng)神經(jīng)外科手術(shù)、介入治療和立體放射治療。 (Minimally invasive neurosurgery is the production of progression of science and the higher demand of peoples health. It includes emerging operations of minimal invasion, interventional neuroradiology and stereotactic

15、radiosurgery)微創(chuàng)神經(jīng)外科產(chǎn)生的學(xué)科背景：各種神經(jīng)外科器械的發(fā)展(Faci現(xiàn)代神經(jīng)外科學(xué)診斷技術(shù)(Modern diagnostic techniques in neurosurgery)電子計(jì)算機(jī)X線體層掃描 （X-CT） 核磁共振成像 （MRI）數(shù)字減影血管造影 （DSA）正電子發(fā)射斷層掃描 （PET）腦磁圖 （ Magnetoencephalogram , MEG） 誘發(fā)電位 （Evoked Potential）現(xiàn)代神經(jīng)外科學(xué)診斷技術(shù)(Modern diagnostic頭顱CTA(Head CTA)頭顱CTA(Head CTA)頭顱MRI(Head MRI)頭顱MRI(Hea

16、d MRI)頭顱MRA(Head MRA)頭顱MRA(Head MRA)頭顱DSA(Head DSA)頭顱DSA(Head DSA)微創(chuàng)神經(jīng)外科學(xué)的內(nèi)容(content of minimally invasive neurosurgery )顯微神經(jīng)外科學(xué)（Microneurosurgery）介入神經(jīng)外科學(xué)（Interventional neurosurgery）影像引導(dǎo)外科學(xué)（Interactive image-guided neurosurgery）神經(jīng)內(nèi)鏡輔助手術(shù)（Endoscopy-assisted neurosurgery）立體定向放射外科（Stereotactic radiosur

17、gery）分子神經(jīng)外科學(xué)（Molecular neurosurgery）微創(chuàng)神經(jīng)外科學(xué)的內(nèi)容(content of minimal顯微神經(jīng)外科（Microneurosurgery） 顯微神經(jīng)外科（Microneurosurgery） 顯微神經(jīng)外科學(xué)是以應(yīng)用手術(shù)顯微鏡為標(biāo)志，但決不能片面的將顯微神經(jīng)外科學(xué)理解為只要手術(shù)中使用手術(shù)顯微鏡就是顯微神經(jīng)外科手術(shù)。(The application of operating microscope for neurosurgery is a necessary condition, but not a sufficient condition) 顯微神經(jīng)外科

18、學(xué)的正確概念，是指以近代影像學(xué)為診斷基礎(chǔ)，一整套與顯微手術(shù)相匹配的手術(shù)設(shè)備、顯微神經(jīng)外科手術(shù)器械為保證的，以顱內(nèi)病灶為中心的手術(shù)。(Microneurosurgery should at least demand the following conditions:1.a operation for intracranial lesions; 2.based on the diagnosis of modern imaging; 3. assisted by a complete set of microsurgical equipment and instruments )顯微神經(jīng)外科學(xué)是以應(yīng)

19、用手術(shù)顯微鏡為標(biāo)志，但決不能片面的將顯微 現(xiàn)代化的神經(jīng)外科手術(shù)室（The modern operating room of neurosurgery） 現(xiàn)代化的神經(jīng)外科手術(shù)室（The modern opera我科醫(yī)師在手術(shù)顯微鏡下進(jìn)行聽神經(jīng)瘤切除術(shù)(The application of microscopy to the treatment of acoustic neuromas )我科醫(yī)師在手術(shù)顯微鏡下進(jìn)行聽神經(jīng)瘤切除術(shù)(The appl顯微鏡下的顱內(nèi)動(dòng)脈瘤夾閉(Clipping of an intracranial aneurysm in the view of operating mi

20、croscope)顯微鏡下的顱內(nèi)動(dòng)脈瘤夾閉(Clipping of an i顯微神經(jīng)外科手術(shù)的特點(diǎn)(The specialties of microneurosurgery)以病灶性為中心手術(shù)，減少腦組織損傷 (An operation centres on the lesion, to the benefit of the avoidance of damage to the surrounding structures)手術(shù)顯微鏡下全新的手術(shù)操作模式 (Brand new microscopic operative surgical technique)顯微神經(jīng)外科手術(shù)的特點(diǎn)(The sp

21、ecialties o隨著顯微神經(jīng)外科技術(shù)的發(fā)展，以及神經(jīng)影像技術(shù)的進(jìn)步，使得一些顱內(nèi)小的、深部腫瘤發(fā)現(xiàn)率得以提高，是病變的解剖定位更加準(zhǔn)確。 (The progression of microneurosurgical and neuroimaging techniques increases the detection ratio of intracranial small and deap lesions and makes the data of anatomy location more accurate)采用顯微神經(jīng)外科技術(shù)，可以利用頭皮小切口、鎖孔入路，以及少暴露、少牽涉病變周圍

22、正常組織，手術(shù)治療這些病變成為可能，從而改變了傳統(tǒng)開顱方式。尤其是術(shù)中導(dǎo)航技術(shù)的引進(jìn)，為鎖孔入路技術(shù)的出現(xiàn)和推廣提供了可靠的技術(shù)保證。(Precise acquisition of the chosen target with minimal disruption to the brain is achieved by using smaller incisions and portals of entry through the skull e.g. the key-hole approach, and by creating a narrow corridor of access to t

23、he target with avoidance of eloquent functional areas of the central nervous system CNS , or important neurovascular structures. Microneurosurgical techniques and computer-assisted navigation are rapidly developing which enable minimalist and increasingly safer intervention within the CNS)隨著顯微神經(jīng)外科技術(shù)

24、的發(fā)展，以及神經(jīng)影像技術(shù)的進(jìn)步，使得一些介入神經(jīng)外科學(xué)(Interventional neurosurgery)介入神經(jīng)外科學(xué)(Interventional neurosu介入神經(jīng)放射學(xué)：是在X線監(jiān)測下，經(jīng)血管等途徑借助引導(dǎo)器械（導(dǎo)管、導(dǎo)絲等）遞送藥物或其他特殊材料進(jìn)入中樞神經(jīng)系統(tǒng)病變區(qū)域，以達(dá)到栓塞、溶解、擴(kuò)張、成形或抗腫瘤等治療目的的一種方法。 (Interventional neurosurgery: with the monitoring by X-ray, drugs or other special materials are delivered to the lesions th

25、routh microcatheters or guidewires placed in intracranial and spinal vessels )治療對(duì)象主要為顱內(nèi)動(dòng)脈瘤、腦和脊髓動(dòng)靜脈畸形、動(dòng)靜脈瘺、硬腦膜動(dòng)靜脈瘺、動(dòng)脈和靜脈竇狹窄、急性腦梗死以及頭頸部腫瘤。 (Application area: intracranial aneurysm, arteriovenous malformation, arteriovenous fistula, dural arteriovenous fistula, arterial and venous sinus stenosis, acute

26、 brain infarction, head and neck neoplasms)介入神經(jīng)放射學(xué)：是在X線監(jiān)測下，經(jīng)血管等途徑借助引導(dǎo)器械（導(dǎo)治療技術(shù)分為血管內(nèi)栓塞術(shù)、血管內(nèi)藥物灌注術(shù)和血管成形術(shù)。上述治療過程的通路或治療對(duì)象是相關(guān)動(dòng)脈和引流靜脈，因此也稱為神經(jīng)外科血管內(nèi)治療學(xué)、血管內(nèi)神經(jīng)外科學(xué)。 (The means of interventional neurosurgery includes endovascular embolization coiling, glue, particulate materrial etc, transcatheter arterial infusi

27、on and angioplasty. The treatment pathway and object are both related arteries and veins. Therefore, interventional neurosurgery is also named as neurosurgical endovascular therapy or endovascular neurosurgery)治療技術(shù)分為血管內(nèi)栓塞術(shù)、血管內(nèi)藥物灌注術(shù)和血管成形術(shù)。上述我科的神經(jīng)介入操作系統(tǒng)(the neurointerventional operative system of our

28、department)我科的神經(jīng)介入操作系統(tǒng)(the neurointerven介入神經(jīng)外科學(xué)在腦血管疾病中的應(yīng)用(Application of interventional neurosurgery in cerebrovascular disorders)動(dòng)脈瘤(Intracranial aneurysm)動(dòng)靜脈畸形(Arteriovenous malformation)動(dòng)靜脈瘺(Arteriovenous fistula)顱內(nèi)動(dòng)脈段狹窄 (Intracranial arterial stenosis)其他(Others)介入神經(jīng)外科學(xué)在腦血管疾病中的應(yīng)用(Application顱內(nèi)動(dòng)脈瘤

29、血管內(nèi)栓塞前后造影對(duì)比(The comparison of an intracranial aneurysm before and after endovascular embolization)顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞前后造影對(duì)比(The comparis頸內(nèi)動(dòng)脈起始段狹窄支架植入前后對(duì)比(The comparison of severe stenosis of proximal segment of unilateral internal carotid artery before and after stenting)頸內(nèi)動(dòng)脈起始段狹窄支架植入前后對(duì)比(The compari頸內(nèi)動(dòng)脈海綿竇瘺

30、球囊栓塞圖示(Embolization with balloon in the treatment of carotid-cavernous sinus fistulas)頸內(nèi)動(dòng)脈海綿竇瘺球囊栓塞圖示(Embolization w介入神經(jīng)放射治療最大的優(yōu)點(diǎn)是避免了開顱手術(shù)帶來的組織創(chuàng)傷，也是微創(chuàng)神經(jīng)外科學(xué)重要的組成部分。(The biggist advantage of interventional neuroradiology therapy is to avoid tissue trauma brought by craniectomy, and the therapy is also a

31、n important part of minimally invasive neurosurgery.)目前介入神經(jīng)放射治療范圍正在拓寬，規(guī)模不斷擴(kuò)大，效果日臻完善，在神經(jīng)外科領(lǐng)域占據(jù)著越來越重要的地位，特別是對(duì)腦血管病的治療已經(jīng)取得了許多突破性進(jìn)展，顯示了一個(gè)具有強(qiáng)大生命力的廣闊前景和領(lǐng)域。(Nowadays interventional neuroradiology therapy becomes more and more important in neurosurgery as its therapy range, scale and effect have developed. E

32、specially for cerebrovascular disorders, the therapy has achieved many breakthroughs. It shows that interventional neuroradiology has extensive developing and application prospect)介入神經(jīng)放射治療最大的優(yōu)點(diǎn)是避免了開顱手術(shù)帶來的組織創(chuàng)傷，也立體定向神經(jīng)外科 (Stereotactic Neurosurgery)立體定向神經(jīng)外科 (Stereotactic Neurosu立體定向神經(jīng)外科經(jīng)歷了有框架的立體定向神經(jīng)外科，

33、目前已經(jīng)發(fā)展了成熟的無框架定位設(shè)備。(Nowadays stereotactic neurosurgery has already developed from the phase of frame-based stereotaxy to the phase of frame-less stereotaxy.) 立體定向神經(jīng)外科目前以神經(jīng)導(dǎo)航為代表，是當(dāng)前微創(chuàng)神經(jīng)外科學(xué)的重要組成部分。(Stereotactic neurosurgery, represented by neuronavigation, is an important part of minimally invasive neu

34、rosurgery at present.)目前，最先進(jìn)的立體定向神經(jīng)外科為術(shù)中MRI技術(shù)。(At present, intraoperative magnetic resonance imaging is the most advanced technique in stereotactic neurosurgery.)立體定向神經(jīng)外科經(jīng)歷了有框架的立體定向神經(jīng)外科，目前已經(jīng)發(fā)展框架立體定向示意(Frame-based Stereotaxy)框架立體定向示意(Frame-based Stereota由于導(dǎo)航外科把現(xiàn)代神經(jīng)影像診斷技術(shù)、立體定向外科和顯微神經(jīng)外科技術(shù)，通過高性能計(jì)算機(jī)結(jié)合起來，

35、能準(zhǔn)確、動(dòng)態(tài)和實(shí)時(shí)顯示神經(jīng)系統(tǒng)解剖結(jié)構(gòu)和病灶的3D空間位置和其毗鄰關(guān)系。 (Navigation combines the techniques of modern neuroimaging diagnosis, stereotactic surgery and microneurosurgery together assisted by high performance computer. It can show the anatomy of the central nervous system, 3D position space of lesions and surrounding no

36、rmal tissue accurately, dynamicly and real-timely.)由于導(dǎo)航外科把現(xiàn)代神經(jīng)影像診斷技術(shù)、立體定向外科和顯微神經(jīng)外神經(jīng)導(dǎo)航影像融合(image-merged techniques in neuronavigation)神經(jīng)導(dǎo)航影像融合(image-merged techniq神經(jīng)導(dǎo)航的優(yōu)點(diǎn)(Advantage of neuronavigation)術(shù)前手術(shù)方案的設(shè)計(jì)(design of preoperative operative schemes )術(shù)中實(shí)時(shí)3D空間定位 (intraoperative real-time 3D spatial l

37、ocalization )顯示術(shù)野周圍的結(jié)構(gòu)(showwing the structure around the operative field)指出目前手術(shù)位置與靶點(diǎn)的3D空間關(guān)系(pointing out the 3D spatial relationships between the operating position and the target)術(shù)中適時(shí)調(diào)整手術(shù)入路(intraoperative adjustment of surgical approaches)顯示入路可能遇到的結(jié)構(gòu)(showwing the structure of the approaches)顯示重要結(jié)構(gòu)(

38、showwing the important structures)顯示病灶切除范圍(showwing the range of resected lesions)神經(jīng)導(dǎo)航的優(yōu)點(diǎn)(Advantage of neuronav它應(yīng)用于顱內(nèi)各種占位病變（如腫瘤、囊腫和膿腫等）、血管畸形、癲癇、顱底腫瘤、先天或后天畸形、鼻竇、脊柱和脊髓病變等。(Neuronavigation surgery is used for the treatment of intracranial mass such as tumor, cyst and abscess, vascular malformation, epi

39、lepsy, skull base tumor, deformity, lesions of spine and spinal cord.)一旦病人資料被注冊(cè)后，系統(tǒng)就可以追蹤手術(shù)探針，從而追蹤手術(shù)的過程，其精確程度可達(dá)毫米。更小的切口、更精確的病變組織切除和減少對(duì)周圍正常組織損傷，降低手術(shù)后并發(fā)癥，改善預(yù)后。(Once the patients information registered, the system can track from the surgical probe to the procedures as accurate as 1 mm, contributing to a

40、 smaller incision, more accurate resection of lesions and lower damage to surrounding normal tissue. It is in favor of reducing post-operative complications and improving prognosis.)它應(yīng)用于顱內(nèi)各種占位病變（如腫瘤、囊腫和膿腫等）、血管畸形、神經(jīng)外科醫(yī)師在神經(jīng)導(dǎo)航下為患者施行深部腦腫瘤手術(shù)(The application of neuronavigation to the treatment of deep bra

41、in tumor)神經(jīng)外科醫(yī)師在神經(jīng)導(dǎo)航下為患者施行深部腦腫瘤手術(shù)(The 開放的MRI導(dǎo)航技術(shù)提高了手術(shù)的安全性、有效性和性能價(jià)格比，并推動(dòng)了神經(jīng)外科的發(fā)展。術(shù)中MRI為導(dǎo)航、確定顱內(nèi)腫瘤邊界，完整安全地切除腫瘤提供了有益的影像信息，減少了手術(shù)并發(fā)癥。 (The open MRI navigation technology improves the safety, effectivity and performance-price ratio of operations and promote the development of neurosurgery. Intraoperative M

42、RI provides useful imaging informations for navigation and identification of the tumor boundary for complete resection. It also reduce the occurance of surgical complications.)開放的MRI導(dǎo)航技術(shù)提高了手術(shù)的安全性、有效性和性能價(jià)格比，術(shù)中MRI導(dǎo)航系統(tǒng)的應(yīng)用，為神經(jīng)外科手術(shù)的發(fā)展提供了廣闊的前景。特別是集神經(jīng)影像、麻醉和手術(shù)設(shè)備為一體的手術(shù)單元出現(xiàn)，可以使手術(shù)完全置于影像學(xué)檢查之中，手術(shù)醫(yī)師可以隨時(shí)將手術(shù)中的病人進(jìn)行磁

43、共振檢查，確定手術(shù)進(jìn)行狀態(tài)，指導(dǎo)手術(shù)，提高手術(shù)效果。這種手術(shù)中應(yīng)用開放式的磁共振的方法，改變了傳統(tǒng)的手術(shù)觀念，相信不久的將來這種具有高端技術(shù)的手術(shù)單元會(huì)在臨床中得到推廣應(yīng)用。(The application of the intraoperative MRI navigation system provides a broad prospect of the development of neurosurgery. Benefiting from the appearance of the operating unit including the equipments of neuroimag

44、ing, anesthesia and surgery, surgeons can performe MRI for patients at any time in a operation to determine the next step to do. The application of open intraoperative MRI changes traditional concept of operation. And the operating unit will be applied in clinic in the near future.)術(shù)中MRI導(dǎo)航系統(tǒng)的應(yīng)用，為神經(jīng)外

45、科手術(shù)的發(fā)展提供了廣闊的前術(shù)中MRI系統(tǒng)(Intraoperative MRI system)術(shù)中MRI系統(tǒng)(Intraoperative MRI sy神經(jīng)內(nèi)鏡輔助手術(shù)(Neuroendoscopy assisted microneurosurgery)神經(jīng)內(nèi)鏡輔助手術(shù)(Neuroendoscopy assis神經(jīng)內(nèi)鏡輔助手術(shù)：利用神經(jīng)內(nèi)鏡亦稱腦室鏡，輔助神經(jīng)外科手術(shù)，可以縮小開顱范圍，放大手術(shù)野內(nèi)解剖結(jié)構(gòu)圖像增強(qiáng)局部光照，提高了手術(shù)效果，屬微創(chuàng)神經(jīng)外科重要技術(shù)。(Neuroendoscopy also named as ventriculoscope assisted microneuros

46、urgery is an important technique of minimally invasive neurosurgery which can reduce the scope of craniotomy, enlarge the view of operating field, enhance local lighting and improve the final effect. )神經(jīng)內(nèi)鏡輔助下的顯微手術(shù)治療顱內(nèi)動(dòng)脈瘤、蛛網(wǎng)膜囊腫、腦室內(nèi)微小病變、經(jīng)單鼻孔切除垂體瘤，獲得良好效果。 (Neuroendoscopy can be used in the operations f

47、or intracranial aneurysm, arachnoid cyst, intraventricular small lesion and pituitary adenoma. The assistance of neuroendoscopy makes a positive effect on operation result.)神經(jīng)內(nèi)鏡輔助手術(shù)：利用神經(jīng)內(nèi)鏡亦稱腦室鏡，輔助神經(jīng)外科手術(shù)，神經(jīng)內(nèi)鏡尸頭解剖訓(xùn)練(Operation training of neuroendoscopy on cadaveric head )神經(jīng)內(nèi)鏡尸頭解剖訓(xùn)練(Operation training神

48、經(jīng)內(nèi)鏡的優(yōu)勢(The advantages of neuroendoscopy)內(nèi)鏡視管本身可帶有側(cè)方視角，可消除術(shù)中死角 (Endoscopy can eliminate intraoperative blind angle with a side view on the canal.)借助立體定向或神經(jīng)導(dǎo)航技術(shù)可以精確定位，能處理常規(guī)手術(shù)難以達(dá)到的部位，對(duì)腦深部或中線部位的病變手術(shù)尤為合適 (With the accurate location provided by stereotactic or neuronavigation technology, surgeons can deal

49、 with the lesions out of reach in routine surgery, especially for the lesions in the deep brain or midline of the brain.)神經(jīng)內(nèi)鏡更適合用于微骨窗入路，手術(shù)侵襲性 (Neuroendoscopy is more suitable for micro bone window craniotomy which is less invasive.)神經(jīng)內(nèi)鏡的優(yōu)勢(The advantages of ne腦室鏡圖示(ventriculoscope)腦室鏡圖示(ventriculosc

50、ope)神經(jīng)內(nèi)鏡的局限性(The limitations of neuroendoscopy)神經(jīng)內(nèi)鏡本身受管徑限制，視野狹小，操作空間小，難于觀察到手術(shù)野全貌，如對(duì)周圍組織解剖不清楚，應(yīng)付手術(shù)意外能力差，極易導(dǎo)致操作失誤。 (Limited by the small caliber of neuroendoscopy, the view of operating field is narrow and the operating space is small. If a surgeon was unfamiliar with the anatomic structures in the op

51、erating field, it would be hard for him to deal with surgical accidents and be easy to make errors in an operation.)神經(jīng)內(nèi)鏡手術(shù)操作需要一定的空間，因此在腦實(shí)質(zhì)內(nèi)圖像顯示不清，無法應(yīng)用。 (Neuroendoscopy assisted surgery requires a certain space. And the images cant be clearly displayed in the brain parenchyma so that the application

52、of neuroendoscopy is relatively limited. )神經(jīng)內(nèi)鏡的局限性(The limitations of n神經(jīng)內(nèi)鏡的局限性(The limitations of neuroendoscopy)神經(jīng)內(nèi)鏡檢查獲得的活體組織學(xué)標(biāo)本太小，缺乏結(jié)論性的病理診斷，這個(gè)問題應(yīng)充分估計(jì)到，并應(yīng)在術(shù)前向病家說明。(The living histological specimens acquired from the neuroendoscopic biopsy may be too small to get a conclusive pathological diagnosi

53、s that should be told to the patient and his family pre-operation.)神經(jīng)內(nèi)鏡手術(shù)，需要配套以較纖細(xì)的、特定形狀的、適合深部操作的器械，器械的配套程度及合理程度有時(shí)可以對(duì)手術(shù)時(shí)間長短，甚至對(duì)手術(shù)效果影響很大。(Neuroendoscopic surgery need to be matched with equipments which are slender, certain shape and suitable for deep operation, or it will influence operative time an

54、d effect.)神經(jīng)內(nèi)鏡只是圍繞手術(shù)提供一個(gè)工具，不能在手術(shù)中單純追求應(yīng)用神經(jīng)內(nèi)鏡，任意擴(kuò)大手術(shù)適應(yīng)癥，會(huì)造成嚴(yán)重的醫(yī)源性損傷。(Neuroendoscopy is just a tool for surgery. Extending the surgical indications arbitrarily will lead to serious iatrogenic injuries.)神經(jīng)內(nèi)鏡的局限性(The limitations of n立體定向放射外科(Stereotactic radiosurgery) 立體定向放射外科(Stereotactic radiosur立體定向放射

55、外科是立體定向技術(shù)與放射治療學(xué)相結(jié)合而形成的一門新興學(xué)科。 (Stereotactic radiosurgery is a new subject combined with stereotactic techniques and radiotherapy.)立體定向放射外科的概念最早由瑞典神經(jīng)外科學(xué)家Leksell提出，是指利用立體定向技術(shù)對(duì)顱內(nèi)靶點(diǎn)精確定位，單次大劑量放射線集中照射于靶組織，使之產(chǎn)生局灶性壞死，從而達(dá)到類似手術(shù)治療的效果。 (The concept of stereotactic radiosurgery was first put forward by the Swedi

56、sh neurosurgeon Leksell, which means to positioning intracranial targets accurately by stereotactic techniques and then delivering focused high dose radiotherapy with relative sparing of surrounding normal structures.The goal is to achieve a similar effect as surgery.)立體定向放射外科是立體定向技術(shù)與放射治療學(xué)相結(jié)合而形成的一門目

57、前，用于立體定向放射外科臨床治療的設(shè)備或稱放射源系統(tǒng)主要有三種：重粒子束放射外科、伽瑪?shù)斗派渫饪坪偷戎行闹本€加速器放射外科或稱X刀，尤以伽瑪?shù)兜膽?yīng)用最為成熟、廣泛。 (At present, there are three kinds of equipments or radiation source systems used in clinical treatment of stereotactic radiosurgery: heavy particles radiosurgery, gamma knife radiosurgery and isocentric linear accelerator radiosurgery (X-knife ). The application of gamma knife is most mature and wide.)目前，用于立體定向放射外科臨床治療的設(shè)備或稱放射源系統(tǒng)主要有立體定向伽馬刀(Stereotactic gamma knife)顱內(nèi)中小直徑的病變