神经内窥镜解剖学研究及临床应用
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摘要
第一部分神经内镜应用解剖学研究
一、神经内镜下鞍区应用解剖研究
目的研究神经内镜下鞍区的解剖特点,探讨其临床应用价值。方法在2具新鲜尸头标本和6具10%甲醛固定尸头标本上采用常规翼点或扩大翼点入路,镜下解剖侧裂并以脑压板牵开额叶、颞叶,在不同角度神经内镜辅助下解剖鞍区并进行观察和测量。结果通过不同的观察角度与解剖间隙,能够在保全正常结构的前提下观察到鞍区各结构。1.1颈内动脉池:主要包含颈内动脉床突上段、PcoA、AchoA和钩动脉;1.2视交叉池:该池包绕视神经和视交叉,其下连接到漏斗和垂体柄,并与鞍隔相连,外侧与颈内动脉池相邻,后方与终板池下部连接,底部与脚间池共用一壁,即Liliquist膜;1.3终板池:位于终板前方,借室管膜和薄层终板与三脑室相隔;1.4脚间池:位于间脑下方,呈圆锥形,侧面与颞叶内面和海马旁回相邻,前下达斜坡,后下达桥脑上缘,后外侧与环池相接。2.1第一间隙:鞍结节后缘至视交叉前缘距离5.5±1.1mm,两侧视神经内侧缘间最大距离10.5±1.3mm;2.2第二间隙:其三边长度分别为6.5±0.6mm,6.8±0.8mm,4.1±0.3mm;2.3第三间隙:其三边长度分别为8.7±0.7mm,6.7±0.6mm,4.4±1.0mm;2.4第四间隙:ACA自ICA分叉处发出后,向内前方走行14.8±1.2mm后通过AcoA与对侧ACA相沟通,AcoA全长1.8±0.2mm。3.1颈内动脉:两侧ICA间距最短的部位75%在床突上,12.5%在海绵窦,12.5%在蝶窦内。3.2大脑中动脉:上、下干大小不一,上干为主者25%,下干为主者31.25%,两干口径相等者占18.75%,多支以及大小不等者占25%;3.3前交通动脉复合体:两侧相等者占43.75%,左侧大于右侧占37.5%,右侧大于左侧占18.75%。前交通动脉复合体变异较大,为动脉瘤的好发部位。3.4后交通动脉:一侧PcoA发达、管径大于或与PCA相当者占31.25%,伴有同侧PCA交通前段不发达。结论神经内镜可以多角度全景式观察,能绕过神经、血管,观察其深面的结构,临床应用可显著提高肿瘤全切率,并保护重要血管神经,减少手术并发症。
二、神经内镜下经鼻蝶手术的应用解剖
目的研究神经内镜下经鼻蝶入路解剖结构的特点,探讨神经内镜在经蝶入路鞍区病变切除术中的潜在价值。方法在2具新鲜尸头标本和6具10%甲醛固定成人尸头标本上采用鼻蝶入路,观察神经内镜下鼻蝶入路各解剖结构的特点及距离。结果鼻小柱根部到蝶窦开口距离64.3±3.2 mm,鼻根到蝶窦开口距离44.8±2.4 mm,蝶窦开口到蝶筛隐窝7.3±3.4 mm,鞍底到鼻小柱根部与中鼻甲下缘连线12.5±2.3 mm。蝶窦口纵径3.5±1.5 mm,蝶窦口横径1.2±0.5 mm,蝶窦口前上端距中线3.0±1.0 mm,蝶窦口下外端距中线3.9±1.2 mm。蝶窦口到同侧视神经11.6±1.8 mm,蝶窦口到同侧颈内动脉13.7±2.2 mm,蝶窦口到鞍结节15.6±3.0 mm,蝶窦口到鞍背22.6±3.2 mm。内窥镜在窦内可以看到颈内动脉隆突、视神经管隆突及鞍底前壁与视交叉前沟下方骨壁转折处的陷窝,转折处常为鞍底打开的中心。0°内镜难以达到满意的鞍内及鞍上暴露,30°镜头可获得理想的暴露,可清楚的看到垂体柄、海绵窦内侧壁、鞍隔、鞍隔孔、前后床突、视神经、视交叉、视交叉前沟、视交叉前间隙、漏斗等结构。讨论神经内镜独特的直观视角,结合专用器械,内镜下经单鼻孔入路可充分暴露蝶鞍区各解剖结构,术者必须熟悉各定位要点和解剖变异的内镜表现,方可避免正常结构的损害,达到安全有效地全切病变。
三、神经内镜下侧脑室应用解剖研究
目的研究神经内窥镜下脑室内结构在各视角下的表现及距离,为安全地脑室内操作提供有效参考资料。方法在2具新鲜尸头标本和6具10%甲醛固定的成人尸头标本上依侧脑室前后角不同的手术入路,观察并测量侧脑室内各解剖标志的特点及距离。结果侧脑室前角到室间孔为(30.3±2.2)mm;侧脑室在前角、室间孔及侧脑室体中部的顶宽及内、外侧壁的高度分别为(16.7±2.1 mm),(16.1±3.0)mm,(23.0±3.6)mm和(18.0±1.6)mm, (17.0±1.9)mm, (24.1±2.5)mm及(13.1±1.7)mm,(8.6±1.3)mm,(15.5±1.4)mm;侧脑室后角到前角、颞角及室间孔距离分别为( 86.5±6.3)mm,(59.6±6.4)mm,(56.3±5.2mm);由丘脑结构形成的脉络丛球与室间孔之间侧脑室底部的弓形隆起高度为(9.9±1.6)mm,侧脑室三角部的最大宽度为(9.3±2.1)mm,三角部上方侧脑室的宽度为(8.3±2.0)mm,三角部下方侧脑室的宽度为(9.4±1.8)mm;眉弓上方侧脑室手术穿刺点到脑室、室间孔距离分别为(29.6±2.5) mm, (55.6±2.4) mm,冠状缝前侧脑室手术穿刺点到脑室、室间孔距离分别为(29.4±2.8)mm、(55.4±3.0) mm。经额角入路观察侧脑室体部、枕角,三脑室底部、后部;经枕角观察到从颞角到额角的脉络丛。在侧脑室内观察的重要‘路标’是室间孔处的Y形结构。结论冠状缝前入路及纵裂入路对于室间孔区病变的暴露和操作有明显优势,操作距离相对较短,容易经室间孔向第三脑室前部推进。眉弓上方入路中由于神经内窥镜的轴线与侧脑室前部一致,有利于前角及体部病变的暴露和操作,且对脑功能的影响较小。侧脑室后角入路比较适合处理三角部及侧脑室体后部的病变。
四、神经内镜下第三脑室应用解剖研究
目的研究第三脑室系统结构在各手术入路的解剖距离及神经内镜下表现,为三脑室内病变神经内镜手术提供指导依据。方法在2具新鲜尸头标本和6具10%甲醛固定成人尸头标本上模拟内镜下经室间孔入路三脑室手术操作,观察并测量侧脑室及三脑室内各解剖标志并记录其内镜下表现。结果本组尸头标本中中间块出现率75%,长径为5.4±1.2(3.2-9.6)mm,短径为2.7±0.9(l.4-5.1) mm。经侧脑室前角入路进入侧脑室后可看到室间孔、脉络丛,进到三脑室内可看到中间块前缘、三脑室顶部的脉络丛结构及前联合、终板结构、视交叉隐窝、漏斗隐窝、中间帆后部、松果体隐窝、后联合、导水管上口。结论室间孔较小时可通过切断同侧穹隆柱扩大室间孔或通过脉络膜裂进入第三脑室;中间块缺如或较小时,工作镜多可顺利暴露三脑室下部及中间块后方结构;三脑室前、中部病变由于接近室间孔,可采用经室间孔入路;三脑室内中、后部病变可采用经脉络膜裂入路。
五、神经内镜下桥小脑角区应用解剖研究
目的研究神经内镜下桥小脑角区的解剖特点,探讨其临床应用价值。方法在6具12侧10%甲醛固定的成人尸头标本和2具4侧新鲜成人尸头标本上采用常规乙状窦后入路,内镜与显微镜结合,对该区血管神经关系进行解剖学研究。并对15例听神经瘤、6例胆脂瘤、5例三叉神经痛患者显微手术中应用内镜对该区行病理解剖观察。结果通过置入不同角度的内镜和变换不同的观察角度与解剖间隙,能够在不破坏正常解剖结构的前提下清晰地观察到CPA区所有的神经血管结构。不同角度的内镜在不同层面的观察中有其独特的价值,可为了解桥小脑角区解剖提供更多的信息。术中在内镜辅助下可提高肿瘤全切率。结论神经内镜和显微镜具有不同的视觉特点,神经内镜与显微镜下的解剖显示并不完全相同。只有全面了解神经内镜下的定位标志和重要结构解剖特点,才能在术中熟练地操作。内镜能越过浅层的阻挡结构,深入到桥小脑角的深部间隙,看到显微镜下显示不清的或不在直线视野内的显微解剖结构。在临床应用可提高肿瘤全切率,保全重要的血管神经结构,减少手术并发症的发生。
第二部分神经内镜的临床应用
一、内镜辅助经蝶垂体腺瘤切除及相关入路比较
目的探讨神经内镜在不同经蝶入路垂体腺瘤切除术中的辅助作用及各手术入路的优缺点。方法对我院收治经蝶手术的500例垂体腺瘤病例的临床资料、手术过程、疗效预后进行回顾性分析,其中改良经口鼻蝶入路200例(内镜辅助20例),经鼻前庭-鼻中隔-蝶窦入路250例(内镜辅助20例),单鼻孔直接经蝶窦入路50例(内镜辅助10例)。结果经蝶手术并发症较少,各组均未出现术后感染等严重并发症,无死亡病例,辅助神经内镜后肿瘤全切率有所提高。结论神经内镜可观察到显微镜管状视野的盲区,提高肿瘤的全切率,为术者提供较显微镜更好的深部照明及图像放大,增加术者对蝶窦及鞍内、鞍上解剖结构的细致观察,为减少术后并发症提供有力的保障。
二、内镜辅助显微手术切除颅内胆脂瘤
目的探讨神经内镜辅助显微神经外科技术在颅内胆脂瘤手术治疗中的应用价值及手术技巧。方法应用神经内镜辅助显微神经外科技术治疗颅内胆脂瘤25例,单纯桥脑小脑角区17例,其中8例从桥脑小脑角延伸至幕上鞍区、斜坡、第三脑室或对侧桥脑小脑角区。手术采用乙状窦后入路17例、翼点入路4例、颞下入路3例、对应的半球入路1例,手术中显微镜下尽可能切除可见肿瘤,尔后再以神经内镜深入探查并切除残留肿瘤。结果所有病例在显微镜下切除满意后,神经内镜深入探查均发现不同程度的肿瘤残留,予以内镜下清除。术毕肿瘤全切23例(92%)。术后21(84%)例原有症状明显缓解,4(16%)例症状部分缓解。结论内镜辅助显微神经外科手术治疗颅内胆脂瘤,能够提高肿瘤全切率,提高手术安全性,减少临近结构损伤,减少术后并发症。
Part 1 The Study of Neuroendoscopic Applied Anatomy
1. endoscopic Anatomical study of the sella region
Objective To study the endoscopic anatomical characteristics of the sella region and to evaluate its clinical application value. Methods two fresh cadaver heads and six cadaver heads fixed by formalin were studied via pterion or enlarged pterion approach. Sylvian fissures were dissected under microscope and the sella region was observed and measured under endoscope and microscope. Results Through different anatomical fissures, with the help of endoscope we could observe all the cisterns around sella region and important anatomical structures in it without any destroy to normal tissues. 1.1 Carotid cistern: in it we could find supraclinoid portion of ICA, PCA, AchoA and uncus artery. 1.2 Optic chiasma cistern: It surrounds optic nerve and optic chiasma. Infundibulum, stalk hypophysial and diaphragma sellae were connected with its floor. Carotid cistern located on its lateral. Bottom of Cisterna lamina terminalis located on its posterior side. And it was separated from interpeduncular cistern by Liliquist membrane on the basalar portion. 1.3 Cisterna lamina terminalis: It seated anterior to the terminal lamina and was separated from the third ventricle by a layer of ependyma and a thin terminal lamina. 1.4 Interpeduncular cistern: It seats inferior to diencephalon and looks like a cop, and also it is close to the medial surface of temporal lobe and hippocampus, and usually entends to clivus at anterior-inferior side, and at posterior-inferior side it entends to superior side of the pons, and it is connected to ambient cistern on the posterior-lateral side. 2.1 The first interspace: The distance between tuberculum sellae and Optic chiasma is 5.5±1.1mm, and the biggest distance between the medial surface of two optic nerve is 10.5±1.3mm. 2.2 The second interspace: The length of three sides are 6.5±0.6mm,6.8±0.8mm,4.1±0.3mm. 2.3 The third interspace: The length of three sides are 8.7±0.7mm,6.7±0.6mm,4.4±1.0mm. 2.4 The fourth interspace: That is the terminal lamina fissure. 3.1 ICA: The closest site of bilateralis usually located at supraclinoid (75%), carvernous sinus (12.5%), and sphenoid sinus (12.5%). 3.2 MCA: The superior trunk and the inferior trunk are not always of the same size. Usually the superior trunk of 25% persons’are bigger, and at 31.25% persons the inferior trunk is bigger, and at 18.75% persons trunks of both side are of the same diameter. 3.3 The complex of AcoA: We observed that in about 43.75% persons calibers of the left side are equal to that of the right side, and in about 37.5% persons calibers of the left side artery are bigger than right side, and in the rest calibers of the left side are smaller than the right side. ACA of both sides are connected together by the AcoA. It has a lot of variation and aneurysms usually locate at this site. 3.4 PcoA: We found that in 31.25% persons calibers of PcoA and PCA are of the same size, and in these cases there must be some maldevelopment on PCA of the same side. Conclusions Neuroendoscope can be used to observe the hidden but important anatomic structures. Endoscope-assisted micro-neurosurgery may provide maximal removal of the lesions, maximal safety of patients, and minimal destruction to normal structures.
2. applied anatomical study of endoscopic operation via trans-sphenoid sinus approach
Objective To study the endoscopic characteristics of anatomic structures on trans-sphenoid sinus approach, and explore the potential values of endoscope in resection of masses on sella area via trans-sphenoid sinus approach.
Methods :The anatomical structures and landmarks of 10 formalin-fixed cadaveric heads, were studied and measured under endoscope via trans-sphenoid sinus approach.
Results :The distance from base of columella nasi to ostia of sphenoidal sinus was (64.3±3.2) mm, distance from radix nasi to ostia of sphenoidal sinus was (44.8±2.4) mm, distance from ostia of sphenoidal sinus to sphenoethmoidal recess was (7.3±3.4) mm,distance from root of sella downward to line through base of columella nasi and middle turbinate was (12.5±2.3) mm. The sagittal diameter of ostia of sphenoidal sinus was (3.5±1.5) mm,The transverse diameter was (1.2±0.5) mm. The distance from the anterio-superior and inferio-exterior end of ostia of sphenoidal sinus to the midline were (3.0±1.0) mm and (3.9±1.2) mm. The distance from the ostia of sphenoidal sinus to tuberculu sellae, internal carotid artery, optic nerve and dorsum sellae were (15.6±3.0) mm,(13.7±2.2) mm,(11.6±1.8) mm,and (22.6±3.2) mm. With the help of endoscope, we could see anatomical landmarks such as knob of ICA, optic canal, and lacune on break-over part of sella base, where is the center to open the sella base. We can not get sufficient exposure of structures in sella or upon sella under zero degree endoscope, but under 30 degree endoscope we can observe structures easily such as stalk hypophysial, medial wall of cavernous, sellae diaphragma, etc. conclusions under the direct visual angle of endoscope, with the specified equipment, anatomical landmarks on trans-sphenoid sinus approach could be exposed sufficiently. The surgeons should be familiar with the endoscopic characteristics of anatomical malformations and landmarks, then normal tissues can be avoided of destruction and masses can be resected safely and totally.
3. endoscopic anatomical study of lateral cerebral ventricle
Objective To study and measure the intra-ventricle structures under different view angles of endoscope, and collect effective reference for safe operation in ventricles. Methods : The anatomical structures and landmarks of 10 formalin-fixed cadaveric heads, were studied and measured under endoscope via different approach to frontal and occipital ventricle horn. Results The distance from frontal horn to interventricular foreman(monro) were (30.3±2.2) mm. The roof width, height of medial and lateral wall of frontal horn were (16.7±2.1)mm, (16.1±3.0)mm, (23.0±3.6)mm, and that at middle body of lateral ventricle and point of Monro’s foramen were (13.1±1.7)mm,(8.6±1.3)mm,(15.5±1.4)mm and (18.0±1.6)mm, (17.0±1.9)mm, (24.1±2.5)mm. The distance from occipital horn to frontal horn, temporal horn and Monro’s foreman were (86.5±6.3)mm, (59.5±6.4)mm and ( 56.3±5.2)mm. The height of arcuate bulge of lateral ventricular bottom between globe of choroids plexus and Monro’s foreman was (9.9±1.6)mm. The utmost width in trigone of ventricle was ( 9.3±2.1)mm. The width of lateral ventricle superior to trigone was (8.3±2.0)mm, and (9.4±1.8)mm at the inferior side. The distances from cortex-punctured point to lateral ventricle and Monro’s foreman in supra-eyebrow approach were (29.6±2.5) mm and (55.6±2.4) mm, and in fore-coronale approach were (29.4±2.8) mm and (55.4±3.0) mm. We observed the body of lateral cerebral ventricle occipital horn, bottom and posterior part of the third ventricle via frontal horn approach; and choroids plexus which extends from temporal horn to frontal horn via occipital horn approach. The most important landmark in ventricle was the“Y”shaped structure nearside Monro’s foramen. Conclusion there are obvious dominance in exposing and operating on the masses located around Monro’s foramen via fore-coronale approach and longitudinal split approach, and the working distance is not very long, and endoscope could be impelled into anterior part of third ventricle through Monro’s foramen easily. Supra-eyebrow approach is suitable for exposing and operating on masses located around frontal horn and body of lateral ventricle, and in this approach there is little destruction to normal neurofunction. Occipital horn approach is suitable for dealing with the masses located around triangular part and posterior part of lateral ventricular body.
4. endoscopic anatomical study of the third ventricle
Objective To study and measure the structures and landmarks in third ventricle under different view angles of endoscope via different operational approach. Methods :The anatomical structures and landmarks of 6 formalin-fixed and 2 fresh cadaveric heads, were studied and measured under endoscope via frontal ventricle horn, occipital ventricle horn and endoscopic Monro’s foramen approach. Results massa intermedia appeared in 75 % specimens. The sagittal and transverse diameter of interthalamic adhesion were (5.4±1.2)mm and (2.7±0.9)mm. We found Monro’s foramen, choroids plexus in lateral ventricle via frontal horn approach, and in third ventricle we found anterior border of massa intermedia, choroids plexus suspending on the roof of third ventricle, terminal plate, recessus infundibuli, rescessus pinealis, upper entrance of aqueduct, etc. Conclusions we can get into third ventricle through cutting off fornix collumn of the same side or choroids fissure when Monro’s foramen is not large enough. Working-scope can expose structures locating inferior to third ventricle and posterior to massa intermedia when massa intermedia is absent or not very large. Because masses locating at anterior third ventricle and middle third ventricle are close to Monro’s foramen, we may choose endoscopic Monro’s foramen approach, but in that locating near posterior third ventricle may choose choroid fissure approach.
5. study of endoscopic anatomy of the cerebello-pontine angle Region
Objective Tr study the anatomic characteristics of the cerebellopontine angle region under the neuroendoscope and its clinical values. Methods We observed the related microdissection of the cerebellopontine angle region of 8 cadavers through retrosigmoid approach by operative microscope and neuroendoscope, in which 2 cadavers were fresh. We also studied the microdissection of the cerebellopontine angle region by operative microscope and neuroendoscope in 15 cases of acoustic neurilemoma, 6 cases of cholesteatoma and 5 cases of trigeminal neuralgia. Results The anatomy of important cerebral cisterns and operative fissures and vessels in the cerebellopontine angle region were observed by various neuroendoscope through various anatomic fissures with minimal invasiveness. Endoscope-assisted microneurosurgery can improve the resection rate of the tumor. Conclusions neuroendoscope has different visual angle from operative microscope. Endoscope can be used to inspect hidden but important anatomic structures in the cerebellopontine angle zone. This study supply the anatomical basis for microneurosurgery, also demonstrate that a good understanding of pathological microanatomy of tumor, as well as its relationship with adjacent neurovascular structures. The neuroendoscope will make up for the deficiencies of the microscope and be of important assistance to the microsurgical operating. Endoscope-assisted microneurosurgery may provide maximum efficiency to remove the lesion, maximum safety for the patient, and minimum invasiveness.
Part 2 The Clinical Application of Neuroendoscope
1. values of endoscope in microneurosurgical resection for pituitary adenomas via sphenoidal sinus approach and comparison of different correlated approach
objective to explore the assisted effect of endoscope in micro-resection for pituitary adenomas via different approach and the merit and defect of each approach. Methods analysis the clinical data, operational process and curative effect of 500 cases who suffered of different kinds of pituitary adenomas and treated in our department via trans-sphenoidal sinus approach, retrospectively. 200 of them were operated via improved mouth-nasal-sphenoidal sinus approach, and 20 of them were operated with the help of endoscope. 250 of them were operated via vestibulum nasi-nasal septum-sphenoidal sinus approach and 20 of them operated with help of endoscope. 50 of them were operated via direct transsphenoidal approach and 10 of them with the help of endoscope. Results there is little complications of operations via transsphenoidal approach. No post-operational infection and death appeared in each group. Total resection rate was improved with the help of endoscope. Conclusion with the help of endoscope we could see structures and masses in blind area of the microscopic tubular visual field, and rate of total resection was improved. Endoscope could provide good lighting of deep part and imaging amplification, which help surgeon get distinct observation of anatomical structures intra-sphenoidal sinus, intra-sella, or supra-sella.
2. Endoscope-assisted microsurgical treatment of intracranial Epidermoid cyst
Objective To study the value of Endoscope-assisted Neurosurgery technique performed in surgical treatment of intracranial epidermoid cyst. Methods Endoscope-assisted Neurosurgery were applied in 25 cases of intracranial epidermoid cysts, in which 17 were Cerebellopontine Angle epidermoids, other 8 cases extended to sellar, clival, third ventricle or opposite CPA region. Craniotomy and surgical approach included suboccipital retrosigmoid (in 17 cases), pterion (in 4 cases), subtemporal (in 3 cases) and transcorticle approach (in 1 cases). Most part of tumors were resected under microscope, then explored and resected the remained tumors under neuroendoscope. Results In these all 25 cases,remained tumors were found under neuroendoscope after routine microsurgery and resected. Total removement rate was 92%(23/25 cases). 21/25 cases (84%) obviously recovered from former symptoms postoperation, 4/25 partially remission. Conclusions Endoscope-assisted neurosugery treatment of intracranial epidermoid cyst can increase total-resection rates, reduce surgery-ralated trauma, improve safety of the operation, reduce occurrence of complications, reduce length of stay.
一、神经内镜下鞍区应用解剖研究
目的研究神经内镜下鞍区的解剖特点,探讨其临床应用价值。方法在2具新鲜尸头标本和6具10%甲醛固定尸头标本上采用常规翼点或扩大翼点入路,镜下解剖侧裂并以脑压板牵开额叶、颞叶,在不同角度神经内镜辅助下解剖鞍区并进行观察和测量。结果通过不同的观察角度与解剖间隙,能够在保全正常结构的前提下观察到鞍区各结构。1.1颈内动脉池:主要包含颈内动脉床突上段、PcoA、AchoA和钩动脉;1.2视交叉池:该池包绕视神经和视交叉,其下连接到漏斗和垂体柄,并与鞍隔相连,外侧与颈内动脉池相邻,后方与终板池下部连接,底部与脚间池共用一壁,即Liliquist膜;1.3终板池:位于终板前方,借室管膜和薄层终板与三脑室相隔;1.4脚间池:位于间脑下方,呈圆锥形,侧面与颞叶内面和海马旁回相邻,前下达斜坡,后下达桥脑上缘,后外侧与环池相接。2.1第一间隙:鞍结节后缘至视交叉前缘距离5.5±1.1mm,两侧视神经内侧缘间最大距离10.5±1.3mm;2.2第二间隙:其三边长度分别为6.5±0.6mm,6.8±0.8mm,4.1±0.3mm;2.3第三间隙:其三边长度分别为8.7±0.7mm,6.7±0.6mm,4.4±1.0mm;2.4第四间隙:ACA自ICA分叉处发出后,向内前方走行14.8±1.2mm后通过AcoA与对侧ACA相沟通,AcoA全长1.8±0.2mm。3.1颈内动脉:两侧ICA间距最短的部位75%在床突上,12.5%在海绵窦,12.5%在蝶窦内。3.2大脑中动脉:上、下干大小不一,上干为主者25%,下干为主者31.25%,两干口径相等者占18.75%,多支以及大小不等者占25%;3.3前交通动脉复合体:两侧相等者占43.75%,左侧大于右侧占37.5%,右侧大于左侧占18.75%。前交通动脉复合体变异较大,为动脉瘤的好发部位。3.4后交通动脉:一侧PcoA发达、管径大于或与PCA相当者占31.25%,伴有同侧PCA交通前段不发达。结论神经内镜可以多角度全景式观察,能绕过神经、血管,观察其深面的结构,临床应用可显著提高肿瘤全切率,并保护重要血管神经,减少手术并发症。
二、神经内镜下经鼻蝶手术的应用解剖
目的研究神经内镜下经鼻蝶入路解剖结构的特点,探讨神经内镜在经蝶入路鞍区病变切除术中的潜在价值。方法在2具新鲜尸头标本和6具10%甲醛固定成人尸头标本上采用鼻蝶入路,观察神经内镜下鼻蝶入路各解剖结构的特点及距离。结果鼻小柱根部到蝶窦开口距离64.3±3.2 mm,鼻根到蝶窦开口距离44.8±2.4 mm,蝶窦开口到蝶筛隐窝7.3±3.4 mm,鞍底到鼻小柱根部与中鼻甲下缘连线12.5±2.3 mm。蝶窦口纵径3.5±1.5 mm,蝶窦口横径1.2±0.5 mm,蝶窦口前上端距中线3.0±1.0 mm,蝶窦口下外端距中线3.9±1.2 mm。蝶窦口到同侧视神经11.6±1.8 mm,蝶窦口到同侧颈内动脉13.7±2.2 mm,蝶窦口到鞍结节15.6±3.0 mm,蝶窦口到鞍背22.6±3.2 mm。内窥镜在窦内可以看到颈内动脉隆突、视神经管隆突及鞍底前壁与视交叉前沟下方骨壁转折处的陷窝,转折处常为鞍底打开的中心。0°内镜难以达到满意的鞍内及鞍上暴露,30°镜头可获得理想的暴露,可清楚的看到垂体柄、海绵窦内侧壁、鞍隔、鞍隔孔、前后床突、视神经、视交叉、视交叉前沟、视交叉前间隙、漏斗等结构。讨论神经内镜独特的直观视角,结合专用器械,内镜下经单鼻孔入路可充分暴露蝶鞍区各解剖结构,术者必须熟悉各定位要点和解剖变异的内镜表现,方可避免正常结构的损害,达到安全有效地全切病变。
三、神经内镜下侧脑室应用解剖研究
目的研究神经内窥镜下脑室内结构在各视角下的表现及距离,为安全地脑室内操作提供有效参考资料。方法在2具新鲜尸头标本和6具10%甲醛固定的成人尸头标本上依侧脑室前后角不同的手术入路,观察并测量侧脑室内各解剖标志的特点及距离。结果侧脑室前角到室间孔为(30.3±2.2)mm;侧脑室在前角、室间孔及侧脑室体中部的顶宽及内、外侧壁的高度分别为(16.7±2.1 mm),(16.1±3.0)mm,(23.0±3.6)mm和(18.0±1.6)mm, (17.0±1.9)mm, (24.1±2.5)mm及(13.1±1.7)mm,(8.6±1.3)mm,(15.5±1.4)mm;侧脑室后角到前角、颞角及室间孔距离分别为( 86.5±6.3)mm,(59.6±6.4)mm,(56.3±5.2mm);由丘脑结构形成的脉络丛球与室间孔之间侧脑室底部的弓形隆起高度为(9.9±1.6)mm,侧脑室三角部的最大宽度为(9.3±2.1)mm,三角部上方侧脑室的宽度为(8.3±2.0)mm,三角部下方侧脑室的宽度为(9.4±1.8)mm;眉弓上方侧脑室手术穿刺点到脑室、室间孔距离分别为(29.6±2.5) mm, (55.6±2.4) mm,冠状缝前侧脑室手术穿刺点到脑室、室间孔距离分别为(29.4±2.8)mm、(55.4±3.0) mm。经额角入路观察侧脑室体部、枕角,三脑室底部、后部;经枕角观察到从颞角到额角的脉络丛。在侧脑室内观察的重要‘路标’是室间孔处的Y形结构。结论冠状缝前入路及纵裂入路对于室间孔区病变的暴露和操作有明显优势,操作距离相对较短,容易经室间孔向第三脑室前部推进。眉弓上方入路中由于神经内窥镜的轴线与侧脑室前部一致,有利于前角及体部病变的暴露和操作,且对脑功能的影响较小。侧脑室后角入路比较适合处理三角部及侧脑室体后部的病变。
四、神经内镜下第三脑室应用解剖研究
目的研究第三脑室系统结构在各手术入路的解剖距离及神经内镜下表现,为三脑室内病变神经内镜手术提供指导依据。方法在2具新鲜尸头标本和6具10%甲醛固定成人尸头标本上模拟内镜下经室间孔入路三脑室手术操作,观察并测量侧脑室及三脑室内各解剖标志并记录其内镜下表现。结果本组尸头标本中中间块出现率75%,长径为5.4±1.2(3.2-9.6)mm,短径为2.7±0.9(l.4-5.1) mm。经侧脑室前角入路进入侧脑室后可看到室间孔、脉络丛,进到三脑室内可看到中间块前缘、三脑室顶部的脉络丛结构及前联合、终板结构、视交叉隐窝、漏斗隐窝、中间帆后部、松果体隐窝、后联合、导水管上口。结论室间孔较小时可通过切断同侧穹隆柱扩大室间孔或通过脉络膜裂进入第三脑室;中间块缺如或较小时,工作镜多可顺利暴露三脑室下部及中间块后方结构;三脑室前、中部病变由于接近室间孔,可采用经室间孔入路;三脑室内中、后部病变可采用经脉络膜裂入路。
五、神经内镜下桥小脑角区应用解剖研究
目的研究神经内镜下桥小脑角区的解剖特点,探讨其临床应用价值。方法在6具12侧10%甲醛固定的成人尸头标本和2具4侧新鲜成人尸头标本上采用常规乙状窦后入路,内镜与显微镜结合,对该区血管神经关系进行解剖学研究。并对15例听神经瘤、6例胆脂瘤、5例三叉神经痛患者显微手术中应用内镜对该区行病理解剖观察。结果通过置入不同角度的内镜和变换不同的观察角度与解剖间隙,能够在不破坏正常解剖结构的前提下清晰地观察到CPA区所有的神经血管结构。不同角度的内镜在不同层面的观察中有其独特的价值,可为了解桥小脑角区解剖提供更多的信息。术中在内镜辅助下可提高肿瘤全切率。结论神经内镜和显微镜具有不同的视觉特点,神经内镜与显微镜下的解剖显示并不完全相同。只有全面了解神经内镜下的定位标志和重要结构解剖特点,才能在术中熟练地操作。内镜能越过浅层的阻挡结构,深入到桥小脑角的深部间隙,看到显微镜下显示不清的或不在直线视野内的显微解剖结构。在临床应用可提高肿瘤全切率,保全重要的血管神经结构,减少手术并发症的发生。
第二部分神经内镜的临床应用
一、内镜辅助经蝶垂体腺瘤切除及相关入路比较
目的探讨神经内镜在不同经蝶入路垂体腺瘤切除术中的辅助作用及各手术入路的优缺点。方法对我院收治经蝶手术的500例垂体腺瘤病例的临床资料、手术过程、疗效预后进行回顾性分析,其中改良经口鼻蝶入路200例(内镜辅助20例),经鼻前庭-鼻中隔-蝶窦入路250例(内镜辅助20例),单鼻孔直接经蝶窦入路50例(内镜辅助10例)。结果经蝶手术并发症较少,各组均未出现术后感染等严重并发症,无死亡病例,辅助神经内镜后肿瘤全切率有所提高。结论神经内镜可观察到显微镜管状视野的盲区,提高肿瘤的全切率,为术者提供较显微镜更好的深部照明及图像放大,增加术者对蝶窦及鞍内、鞍上解剖结构的细致观察,为减少术后并发症提供有力的保障。
二、内镜辅助显微手术切除颅内胆脂瘤
目的探讨神经内镜辅助显微神经外科技术在颅内胆脂瘤手术治疗中的应用价值及手术技巧。方法应用神经内镜辅助显微神经外科技术治疗颅内胆脂瘤25例,单纯桥脑小脑角区17例,其中8例从桥脑小脑角延伸至幕上鞍区、斜坡、第三脑室或对侧桥脑小脑角区。手术采用乙状窦后入路17例、翼点入路4例、颞下入路3例、对应的半球入路1例,手术中显微镜下尽可能切除可见肿瘤,尔后再以神经内镜深入探查并切除残留肿瘤。结果所有病例在显微镜下切除满意后,神经内镜深入探查均发现不同程度的肿瘤残留,予以内镜下清除。术毕肿瘤全切23例(92%)。术后21(84%)例原有症状明显缓解,4(16%)例症状部分缓解。结论内镜辅助显微神经外科手术治疗颅内胆脂瘤,能够提高肿瘤全切率,提高手术安全性,减少临近结构损伤,减少术后并发症。
Part 1 The Study of Neuroendoscopic Applied Anatomy
1. endoscopic Anatomical study of the sella region
Objective To study the endoscopic anatomical characteristics of the sella region and to evaluate its clinical application value. Methods two fresh cadaver heads and six cadaver heads fixed by formalin were studied via pterion or enlarged pterion approach. Sylvian fissures were dissected under microscope and the sella region was observed and measured under endoscope and microscope. Results Through different anatomical fissures, with the help of endoscope we could observe all the cisterns around sella region and important anatomical structures in it without any destroy to normal tissues. 1.1 Carotid cistern: in it we could find supraclinoid portion of ICA, PCA, AchoA and uncus artery. 1.2 Optic chiasma cistern: It surrounds optic nerve and optic chiasma. Infundibulum, stalk hypophysial and diaphragma sellae were connected with its floor. Carotid cistern located on its lateral. Bottom of Cisterna lamina terminalis located on its posterior side. And it was separated from interpeduncular cistern by Liliquist membrane on the basalar portion. 1.3 Cisterna lamina terminalis: It seated anterior to the terminal lamina and was separated from the third ventricle by a layer of ependyma and a thin terminal lamina. 1.4 Interpeduncular cistern: It seats inferior to diencephalon and looks like a cop, and also it is close to the medial surface of temporal lobe and hippocampus, and usually entends to clivus at anterior-inferior side, and at posterior-inferior side it entends to superior side of the pons, and it is connected to ambient cistern on the posterior-lateral side. 2.1 The first interspace: The distance between tuberculum sellae and Optic chiasma is 5.5±1.1mm, and the biggest distance between the medial surface of two optic nerve is 10.5±1.3mm. 2.2 The second interspace: The length of three sides are 6.5±0.6mm,6.8±0.8mm,4.1±0.3mm. 2.3 The third interspace: The length of three sides are 8.7±0.7mm,6.7±0.6mm,4.4±1.0mm. 2.4 The fourth interspace: That is the terminal lamina fissure. 3.1 ICA: The closest site of bilateralis usually located at supraclinoid (75%), carvernous sinus (12.5%), and sphenoid sinus (12.5%). 3.2 MCA: The superior trunk and the inferior trunk are not always of the same size. Usually the superior trunk of 25% persons’are bigger, and at 31.25% persons the inferior trunk is bigger, and at 18.75% persons trunks of both side are of the same diameter. 3.3 The complex of AcoA: We observed that in about 43.75% persons calibers of the left side are equal to that of the right side, and in about 37.5% persons calibers of the left side artery are bigger than right side, and in the rest calibers of the left side are smaller than the right side. ACA of both sides are connected together by the AcoA. It has a lot of variation and aneurysms usually locate at this site. 3.4 PcoA: We found that in 31.25% persons calibers of PcoA and PCA are of the same size, and in these cases there must be some maldevelopment on PCA of the same side. Conclusions Neuroendoscope can be used to observe the hidden but important anatomic structures. Endoscope-assisted micro-neurosurgery may provide maximal removal of the lesions, maximal safety of patients, and minimal destruction to normal structures.
2. applied anatomical study of endoscopic operation via trans-sphenoid sinus approach
Objective To study the endoscopic characteristics of anatomic structures on trans-sphenoid sinus approach, and explore the potential values of endoscope in resection of masses on sella area via trans-sphenoid sinus approach.
Methods :The anatomical structures and landmarks of 10 formalin-fixed cadaveric heads, were studied and measured under endoscope via trans-sphenoid sinus approach.
Results :The distance from base of columella nasi to ostia of sphenoidal sinus was (64.3±3.2) mm, distance from radix nasi to ostia of sphenoidal sinus was (44.8±2.4) mm, distance from ostia of sphenoidal sinus to sphenoethmoidal recess was (7.3±3.4) mm,distance from root of sella downward to line through base of columella nasi and middle turbinate was (12.5±2.3) mm. The sagittal diameter of ostia of sphenoidal sinus was (3.5±1.5) mm,The transverse diameter was (1.2±0.5) mm. The distance from the anterio-superior and inferio-exterior end of ostia of sphenoidal sinus to the midline were (3.0±1.0) mm and (3.9±1.2) mm. The distance from the ostia of sphenoidal sinus to tuberculu sellae, internal carotid artery, optic nerve and dorsum sellae were (15.6±3.0) mm,(13.7±2.2) mm,(11.6±1.8) mm,and (22.6±3.2) mm. With the help of endoscope, we could see anatomical landmarks such as knob of ICA, optic canal, and lacune on break-over part of sella base, where is the center to open the sella base. We can not get sufficient exposure of structures in sella or upon sella under zero degree endoscope, but under 30 degree endoscope we can observe structures easily such as stalk hypophysial, medial wall of cavernous, sellae diaphragma, etc. conclusions under the direct visual angle of endoscope, with the specified equipment, anatomical landmarks on trans-sphenoid sinus approach could be exposed sufficiently. The surgeons should be familiar with the endoscopic characteristics of anatomical malformations and landmarks, then normal tissues can be avoided of destruction and masses can be resected safely and totally.
3. endoscopic anatomical study of lateral cerebral ventricle
Objective To study and measure the intra-ventricle structures under different view angles of endoscope, and collect effective reference for safe operation in ventricles. Methods : The anatomical structures and landmarks of 10 formalin-fixed cadaveric heads, were studied and measured under endoscope via different approach to frontal and occipital ventricle horn. Results The distance from frontal horn to interventricular foreman(monro) were (30.3±2.2) mm. The roof width, height of medial and lateral wall of frontal horn were (16.7±2.1)mm, (16.1±3.0)mm, (23.0±3.6)mm, and that at middle body of lateral ventricle and point of Monro’s foramen were (13.1±1.7)mm,(8.6±1.3)mm,(15.5±1.4)mm and (18.0±1.6)mm, (17.0±1.9)mm, (24.1±2.5)mm. The distance from occipital horn to frontal horn, temporal horn and Monro’s foreman were (86.5±6.3)mm, (59.5±6.4)mm and ( 56.3±5.2)mm. The height of arcuate bulge of lateral ventricular bottom between globe of choroids plexus and Monro’s foreman was (9.9±1.6)mm. The utmost width in trigone of ventricle was ( 9.3±2.1)mm. The width of lateral ventricle superior to trigone was (8.3±2.0)mm, and (9.4±1.8)mm at the inferior side. The distances from cortex-punctured point to lateral ventricle and Monro’s foreman in supra-eyebrow approach were (29.6±2.5) mm and (55.6±2.4) mm, and in fore-coronale approach were (29.4±2.8) mm and (55.4±3.0) mm. We observed the body of lateral cerebral ventricle occipital horn, bottom and posterior part of the third ventricle via frontal horn approach; and choroids plexus which extends from temporal horn to frontal horn via occipital horn approach. The most important landmark in ventricle was the“Y”shaped structure nearside Monro’s foramen. Conclusion there are obvious dominance in exposing and operating on the masses located around Monro’s foramen via fore-coronale approach and longitudinal split approach, and the working distance is not very long, and endoscope could be impelled into anterior part of third ventricle through Monro’s foramen easily. Supra-eyebrow approach is suitable for exposing and operating on masses located around frontal horn and body of lateral ventricle, and in this approach there is little destruction to normal neurofunction. Occipital horn approach is suitable for dealing with the masses located around triangular part and posterior part of lateral ventricular body.
4. endoscopic anatomical study of the third ventricle
Objective To study and measure the structures and landmarks in third ventricle under different view angles of endoscope via different operational approach. Methods :The anatomical structures and landmarks of 6 formalin-fixed and 2 fresh cadaveric heads, were studied and measured under endoscope via frontal ventricle horn, occipital ventricle horn and endoscopic Monro’s foramen approach. Results massa intermedia appeared in 75 % specimens. The sagittal and transverse diameter of interthalamic adhesion were (5.4±1.2)mm and (2.7±0.9)mm. We found Monro’s foramen, choroids plexus in lateral ventricle via frontal horn approach, and in third ventricle we found anterior border of massa intermedia, choroids plexus suspending on the roof of third ventricle, terminal plate, recessus infundibuli, rescessus pinealis, upper entrance of aqueduct, etc. Conclusions we can get into third ventricle through cutting off fornix collumn of the same side or choroids fissure when Monro’s foramen is not large enough. Working-scope can expose structures locating inferior to third ventricle and posterior to massa intermedia when massa intermedia is absent or not very large. Because masses locating at anterior third ventricle and middle third ventricle are close to Monro’s foramen, we may choose endoscopic Monro’s foramen approach, but in that locating near posterior third ventricle may choose choroid fissure approach.
5. study of endoscopic anatomy of the cerebello-pontine angle Region
Objective Tr study the anatomic characteristics of the cerebellopontine angle region under the neuroendoscope and its clinical values. Methods We observed the related microdissection of the cerebellopontine angle region of 8 cadavers through retrosigmoid approach by operative microscope and neuroendoscope, in which 2 cadavers were fresh. We also studied the microdissection of the cerebellopontine angle region by operative microscope and neuroendoscope in 15 cases of acoustic neurilemoma, 6 cases of cholesteatoma and 5 cases of trigeminal neuralgia. Results The anatomy of important cerebral cisterns and operative fissures and vessels in the cerebellopontine angle region were observed by various neuroendoscope through various anatomic fissures with minimal invasiveness. Endoscope-assisted microneurosurgery can improve the resection rate of the tumor. Conclusions neuroendoscope has different visual angle from operative microscope. Endoscope can be used to inspect hidden but important anatomic structures in the cerebellopontine angle zone. This study supply the anatomical basis for microneurosurgery, also demonstrate that a good understanding of pathological microanatomy of tumor, as well as its relationship with adjacent neurovascular structures. The neuroendoscope will make up for the deficiencies of the microscope and be of important assistance to the microsurgical operating. Endoscope-assisted microneurosurgery may provide maximum efficiency to remove the lesion, maximum safety for the patient, and minimum invasiveness.
Part 2 The Clinical Application of Neuroendoscope
1. values of endoscope in microneurosurgical resection for pituitary adenomas via sphenoidal sinus approach and comparison of different correlated approach
objective to explore the assisted effect of endoscope in micro-resection for pituitary adenomas via different approach and the merit and defect of each approach. Methods analysis the clinical data, operational process and curative effect of 500 cases who suffered of different kinds of pituitary adenomas and treated in our department via trans-sphenoidal sinus approach, retrospectively. 200 of them were operated via improved mouth-nasal-sphenoidal sinus approach, and 20 of them were operated with the help of endoscope. 250 of them were operated via vestibulum nasi-nasal septum-sphenoidal sinus approach and 20 of them operated with help of endoscope. 50 of them were operated via direct transsphenoidal approach and 10 of them with the help of endoscope. Results there is little complications of operations via transsphenoidal approach. No post-operational infection and death appeared in each group. Total resection rate was improved with the help of endoscope. Conclusion with the help of endoscope we could see structures and masses in blind area of the microscopic tubular visual field, and rate of total resection was improved. Endoscope could provide good lighting of deep part and imaging amplification, which help surgeon get distinct observation of anatomical structures intra-sphenoidal sinus, intra-sella, or supra-sella.
2. Endoscope-assisted microsurgical treatment of intracranial Epidermoid cyst
Objective To study the value of Endoscope-assisted Neurosurgery technique performed in surgical treatment of intracranial epidermoid cyst. Methods Endoscope-assisted Neurosurgery were applied in 25 cases of intracranial epidermoid cysts, in which 17 were Cerebellopontine Angle epidermoids, other 8 cases extended to sellar, clival, third ventricle or opposite CPA region. Craniotomy and surgical approach included suboccipital retrosigmoid (in 17 cases), pterion (in 4 cases), subtemporal (in 3 cases) and transcorticle approach (in 1 cases). Most part of tumors were resected under microscope, then explored and resected the remained tumors under neuroendoscope. Results In these all 25 cases,remained tumors were found under neuroendoscope after routine microsurgery and resected. Total removement rate was 92%(23/25 cases). 21/25 cases (84%) obviously recovered from former symptoms postoperation, 4/25 partially remission. Conclusions Endoscope-assisted neurosugery treatment of intracranial epidermoid cyst can increase total-resection rates, reduce surgery-ralated trauma, improve safety of the operation, reduce occurrence of complications, reduce length of stay.
引文
1) Perneczky A, Tschabitscher M, Resch K Endoscopic anatomy for neurosurgery. Stuttaat: Thieme. New York. 1994
2) Cohen A R, Perneczky A, Rodziewicz G S, et al. Endoscope–assisted craniotomy: Approach to the rostral brain stem [J]. Neurosurgery, 1995, 36 (6): 1128-1130
3) Czirjak S, Szeifert G. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision [J]. Neurosurgery, 2001, 48(1): 145-150
4) Fries G, Perneczky A, von Lindert E, et al. Contra lateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysm [J]. Neusurgery, 1997, 41(2): 333-343
5) Hiroyuki Kinouchi, Katsuya Futawatari, Kazou Mizoi, et al. Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process [J]. J Neurosurg, 2002, 96(4): 788-791
6) Perneczky A, Fries G. Endoscope-assisted brain surgery: Part1-Evolution, basicconcept, and current technique [J]. Neurosurgery, 1998, 42(2): 219-225
7) Taniguchi M, Takimoto H, Yoshimine T, et al. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosurg, 1999, 91(2): 231-237
8) Hiroyuki Kinouchi, Katsuya Futawatari, Kazou Mizoi, et al. Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process. J Neurosurg, 2002, 96(4): 788-791
9) De Oliveira E, Tedeschi H, Siqueira MG, et al. Anatomical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir (wien), 1996, 138: 1-11
10) Perneczky A,Boecher Schwarz HG.. Endoscope-assisted microsurgery for cerebral aneurysms [J]. Neurol Med Chir Tokyo, 1998, 38 Suppl: 33-34
11) Fries G, Perneczky A, von Lindert E, et al. Contra lateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysm [J]. Neurosurgery, 1997, 41(2): 333-343
12) Taniguchi M, Takimoto H, Yoshimine T, et al. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosurg, 1999, 91(2): 231-237
13) Steiger HJ, Schmid-Elsaesser R, stummer W, et al. Transorbital keyhole approach to anterior communicating artery aneurysms [J]. Neurosurgery, 2001, 48: 347-351
14) Yasargil. General operative techniques. In: Yasargil MG, ed. Microneurosurgery. Vo l. New York: Georg Thieme Verlag Stutzgur, 1984. 208-71
15) Cohen A R, Perneczky A, Rodziewicz G S, et al. Endoscope-assisted craniotomy: Approache to the rostral brain stem. Neurosurgery, 1995, 36(6): 1128-1130
16) Menovsky T,Grotenhuis JA,de Vries J , et al. Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa [J]. Neurosurgery, 1999, 44(1): 106-110
17) Kim M H,Jho H D. Endoscopic reverse third ventriculostomy via the cisterna magna: anatomical study and proposal of a novel procedure [J]. Minim Invasive Neurosurg, 2002, 45(2): 84-86
18) Fries G, Perneczky A. Endoscope-assisted brain surgery: Part 2-analysis of 380 procedures [J]. Neurosurgery, 1998, 42(2): 226-232
19) Tamaki N, Hara Y, Takaishi Y, et al. Angled rigid neuroendoscope for continuous intraoperative visual monitoring: technical note [J]. J Clin Neurosci, 2001, 8(2): 148-150
20) King WA, Wackym PA. Endoscope-assisted surgery for acoustic neuromas (vestibular schwannomas): Early experience using the Rigid Hopkins telescope [J]. Neurosurgery, 1999, 44(5): 1095-1100
21) Kalavakonda C, Laligam N. Sekhar, Ramachandran P, et al. Endoscope-assisted microsurgery for intracranial aneurysms [J]. Neurosurgery, 2002, 51: 1119-1125
22)丰育功,朱贤立,张俊亭,等.经翼点入路鞍区手术间隙的显微解剖研究[J].中华神经外科杂志, 2000, 16(4): 222-225
23) Cohen A R, Perneczky A, Rodziewicz G S, et al. Endoscope-assisted craniotomy: Approache to the rostral brain stem [J]. Neurosurgery, 1995, 36(6): 1128-1130
24) Czirjak S, Szeifert G. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision [J]. Neurosurgery, 2001, 48(1): 145-150
25) Fries G, Perneczky A, von Lindert E, et al. Contra lateral and ipsilateral microsurgical approaches to carotid - ophthalmic aneurysm [J]. Neusurgery, 1997, 41(2): 333-343
26) Hiroyuki Kinouchi, Katsuya Futawatari, Kazou Mizoi, et al. Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process [J]. J Neurosurg, 2002, 96(4): 788-791
27) Perneczky A, Fries G. Endoscope-assisted brain surgery: Part1-Evolution, basic concept, and current technique [J]. Neurosurgery, 1998, 42(2): 219-225
28) Taniguchi M, Takimoto H, Yoshimine T, et al. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosurg, 1999, 91(2): 231-237
29)凌锋译.显微神经外科学[M].北京:中国科学技术出版社, 2001, 209– 227
30)吴建东,惠国桢,夏春林,等.垂体上动脉显微外科解剖学研究[J].中华神经外科杂志, 2000, 16: 146-148
31) Guilio M, Carmilo A, Cesare C, et al. Craniopharyngiomas of the third ventricle: trans - lamina terminalis approach [J]. Neurosurgery, 2000, 47(4): 857-865
32)夏春林,惠国桢. Willis氏环前部与前交通动脉瘤相关的显微解剖研究[J].中华神经外科杂志, 1991, 7: 255-258
1) Jho HD, Alfieri A. Endoscopic Endonasal Pituitary Surgery: Evolution of Surgical Technique and Equipmeng in 150 Operations [J]. Minim Invas Neurosurg, 2001,44(l): l-12
2) Jho HD, Alfieri A. Endoscopic transsphenoidal pituitary: various surgical techniques and recommended steps for procedural transition [J]. Br J Neurosurg, 2000, 14(5): 432-440
3) Carl B H, William A S, Elie E R. Endoscopic Sphenoidotomy Approach to the Sella [J]. Neurosurgery, 1997, 41(3): 602-607
4)王忠诚.神经外科临床解剖学[M].山东:山东科学技术出版社, 2001, 101-105
5)周定标.颅底肿瘤手术学[M].北京:人民军医出版社, 1997, 313-316
6)廖建春,陈菊祥,王海青,等.蝶窦的影象解剖学研究[J].中国临床解剖学杂志, 1999, 17(4): 309-311
7)范静平,廖建春,吴建,等.内窥镜蝶窦及鞍区手术应用解剖学研究[J].中国临床解剖学杂志, 1996, 14(2): 95-98
8)陶海,马志中,姜荔.视神经管的显微解剖及临床意义[J].中国临床解剖学杂志, 2000, 18(4): 296-298
9)范建平,章松勤,廖建春,等.内窥镜视神经管减压术应用解剖[J].中国临床解剖学杂志, 1996, 14(2): 92-94
10)张亚卓,王忠诚,等.神经内窥镜技术的临床应用[J].中华神经外科杂志, 2000, 16(1): 3-7
11)蔡瑜综述.内窥镜技术在经蝶垂体瘤手术中的运用进展[J].国外医学神经病学神经外科学分册, 1998, 25(5): 240-242
12) Jarrahy, Yi Min Suh, et al. Endoscopic pituitary: an in vivo model for transnasal transsphenoid hypophysectomy [J]. J Laparoendosc Adv Surg Tech A, 1999, 9(2): 211-219
13) Jho HD, Ricardo L, Carrau. Endoscopic Endonasal Transspenoidal Surgery: Experience with 50 patients [J]. Neurosurg, 1997, 7(87): 44-51
14) Yamv E, Rappaport ZH. Endoscopic Transseptal Transsphenoidal Surgery for pituitary tumors [J]. Neurosurgery, 1997, 5(40): 944-946
15)魏少波,周定标,张纪,等.经单鼻孔蝶窦入路切除垂体肿瘤.中国微侵袭神经外科杂志, 2001, 6: 72-75
16)孙炜,庞琦,张庆林,等.经单侧鼻腔一蝶窦入路切除垂体腺瘤[J].中国微侵袭神经外科杂志, 2001, 9: 76-78
17)廖建春,吕春雷,王海青,等.最后筛房的影像解剖学研究[J].中国临床解剖学杂志, 1999, 17(4): 298-299
18)史剑波,许庚,徐锦堂,等.经鼻内窥镜视神经管减压术的解剖和临床研究[J].中国内镜杂志, 1997, 3(5): 13-15
19)孙敬武,王银凤,陈晓虹,等.经鼻内窥镜蝶窦鞍区手术解剖及临床应用[J].中国临床解剖学杂志, 2000, 18(3): 199-200
1) Perneczky A, Muller-Forell W, van Lindert E, et al. Keyhole concept in neurosurgery: with endoscope-assisted microsurgery and case studies [M]. New York: Thieme, 1999: 1-100
2)王忠诚.神经外科学[M].湖北,湖北科学技术出版社. 1998. 154-155
3)张亚卓,等.脑室外科手术学[M].北京,中国协和医科大学出版社. 2001. 169-171
4)张亚卓,王忠诚,等.神经内窥镜技术的临床应用[J].中华神经外科杂志, 2000, 16(1): 3-7
5)高鲜红,何乐,张亚卓,等.侧脑室、三脑室神经内镜应用解剖[J].中华神经外科杂志, 2001, 17(4): 223-226
6)周庭永,韩景茹,马贻玲.侧脑室的横断面解剖学研究[J].解剖学杂志, 1997, 20(3): 289-292
7)陈谦学,郑晓华,刘仁忠.成人侧脑室正常值的测定及其临床意义[J].湖北医科大学学报, 1996, 17(4): 365-366
8)陆生九,狄荣科,刘益仁,等.室间孔的形态学研究[J].解剖学杂志, 1996, 19(1): 4-7
9)唐勇,母其文,陈联盟.人体侧脑室容量年龄变化的研究[J].解剖学杂志, 1995, 18(2): 108-110
10)郭宇,李幼琼.侧脑室的医学三维重建研究[J].解剖科学进展, 1999, 5(3): 276-279
11)高振平,吕衡发,李幼琼,等.侧脑室三维断层影像解剖学应用研究[J].解剖学杂志, 1998, 27(4): 62-65
12)李幼琼,张立忠,王野成.侧脑室的三维重建及应用研究[J].解剖学杂志, 2000, 23(22): 85-86
13)王可人,郭京丽,鲁澄宇,等.侧脑室计算机三维重建及理论分析[J].白求恩医科大学学报, 2001, 27(4): 344-346
14)李幼琼,王可人,董国军,等.侧脑室三维重建及立体观测[J].第四军医大学吉林军医学院学报, 2001, 23(2): 94-95
15)刘正清,文小丹,彭光春,等.正常中老年人活体侧脑室容量的CT测量[J].解剖学研究, 2001, 23(3): 222-223
16)亢建民,梁恩和,姚鑫,等.改良的成人脑室额角穿刺定位术[J].天津医药, 2001, 29(12): 722-723
17) Natori Y, Fukui M, Rhoton A L. Anterior interhemispheric transcallosal approach for lateral ventricle lesions [J]. No Shinkei Geka, 1997, 25(9): 777-784
18) Switka A, Narkiewicz O, Dziewiatkowski J, et al. The shape of the inferior horn of the lateral ventricle in relation to collateral and occipitotemporal sulci [J]. Folia Morphol (Warsz), 1999, 58(2): 69-80
19) Mu Q, Xie J, Wen Z, et al. A quantitative MR study of the hippocampal formation, the amygdala, and the temporal horn of the lateral ventricle in healthy subjects 40 to 90 years of age [J]. Am J Neuroradiol, 1999, 20(2): 207-211
1) Decq P, Le Guerinel C, Sol J C, etl. Endoscopic anatomy of the third ventricle [J]. Neurochirurgie, 2000, 46(3): 203-208
2)万经海.内窥镜神经解剖学[J].微侵袭神经外科杂志, 1997, 2(3): 215-217
3)高鲜红,何乐,张亚卓.侧脑室、三脑室神经内镜应用解剖[J].中华神经外科杂志, 2001, 17(4): 223-226
4)雷小环,等.第三脑室的显微外科解剖[J].中国神经精神病杂志, 1986, 12(6): 321-325
5)马廉亭.微侵袭神经外科学[M].北京:人民军医出版社. 1999, 508-512
6)张亚卓,刘恩重,等.脑室外科手术学[M].北京:中国协和医科大学出版社, 2001. 46-50
7)李幼琼,高振平,王晓慧.第三脑室三维断层影像解剖学及其临床意义[J].中国临床解剖学杂志, 1999, 17(1): 39-40
8)李幼琼,高振平,吕衡发.第三脑室三维断层影像解剖学研究[J].解剖学杂志, 1998, 21: 62-65
9)李幼琼,高振平,苏略.第三脑室区域的显微断层解剖学研究[J].长春中医学院学报, 1998, 14(4): 34-37
10)韩文江.第三脑室的显微外科解剖[J].论文汇编, 1988, 6: 90-93
11)何润昌.第三脑室后部显微外科解剖[J].中华神经外科杂志, 1986, 3:159-164
12)钱学华,姜均本.人脑松果体区域的断面解剖学研究[J].解剖学报, 1995, 26(4): 337-340
13)王海杰.中间块的观察和测量[J].解剖学杂志, 1992, 2: 140-143
14)陆生九,狄荣科,刘益仁.室间孔的形态学研究[J].解剖学杂志, 1996, 19(1): 4-7
15)宋鹤九,陈玉敏,常义.在前连合前,脱服体梯度坐标值的解剖定位[J].功能性和立体定向神经外科杂志, 1995, 8(4): 1-3
16)傅先明.三脑室宽度和内囊位置的关系[J].功能性和立体定向神经外科杂志, 1991, (2): 8-9
17) Nikolai J H, Peter G, Georg F.经内窥镜的第三脑室切开术((ETV): 100例分析[J].德国医学, 1999, 16(6): 325-327
18) Okamoto S, Narumi O. Operative approaches to tumors in and around the anterior half of the third ventricle [J]. No Shinkei Geka, 2002, 30(9): 923-932
19) Wen H T, Rhoton A L, De Oliveira E. Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application [J]. Neurosurgery, 1998, 42(6): 1205-1217
20) Winkler P A, Weis S, Buttner A, et al. The transcallosal interforniceal approach to the third ventricle: anatomic and microsurgical aspects [J]. Neurosurgery, 1997, 40(5): 973-982
21) Iordachescu A, Ianovici N. Tumors of the third ventricle. Rev Med Chir Soc Med Nat Iasi, 1997, 101(3-4): 145-151
1) O'Donoghue GM, O'Flynn P. Endoscopic anatomy of the cerebellopontine [J]. Am J Otology, 1993; 14(2):122~125
2) Rhoton AL Jr. The posterior cranial fossa: microsurgical anatomy and surgical approaches [J]. Neurosurgery, 2000, 47(Suppl3): 129-130
3) Lister J, Rhoton AL Jr, Matsushima T, et al. Microsurgical anatomy of the posterior inferior cerebellar artery [J]. Neurosurg, 1982; 10(2): 170~199
4) Salas E, Ziyal IM, Bank WO, et al. Extradural origin of the posteroinferior cerebellar artery: an anatomic correlation [J]. Neurosurg, 1998; 42(6): 1326~1331
5) Fine A, Cardoso A, Rhoton AL. Microsurgical anatomy of the extracranial-extradural origin of the posterior inferior cerebellar artery [J]. J Neurosurg, 1999; 91(4): 645~652
6) Goksu N, Bayazit Y, Kemaloglu Y. Endoscopy of the posterior fossa and dissection of acoustic ncuroma. J Neurosurg, 1999, 91(5):776-780
7) Tatagiba M, Samii M, Matthies C, et al. The significance for postoperative hearing of preserving the labyrinth in acoustic neurinoma surgery[J]. J neurosurg 77:677~684, 1992
8) C.Matula, J.Diaz Day, T.Czech, et al. The Retrosigmoid Approach to Acoustic Neurinomas: Technical, Strategic, and Future Concepts [J]. Acta Neurochir (Wien), 1995, 134; 139~147
9)江涛,王忠诚,于春江等.单侧枕下乙状窦后入路磨开内耳道后壁与骨迷路保护[J].中华神经外科杂志,1999,15(4):196~199
10) King WA, Wackym PA, Sen C, et al. Adjunctive us of endoscopy during posterior fossa surgery to treat cranial neuropathies [J]. Neurosurgery, 2001; 49(1):108~116
11) Janetta PJ. Neurovascular vompression in cranial nerve and systemic disease. Ann Surg, 1980, 192: 518~525
12) Huang CI, Chen IH, Lee LS: Microvascular decompression for hemifacial spasm: Analysis of operative findings and results in 310 patients. Neurosurgery 1992,30:53～57
13) Jannetta PJ: Treatment of trigeminal neuralgia by micro operative decompression, in Youmans JR (ed): Neurological Surgery. Philadelphia, W. B. Saunders Co., 1996, pp 3589~3603
14) Lovely TJ, Jannetta PJ: Microvascular decompression for trigeminal neuralgia: Surgical technique and long~term results. Neurosurg Clin N Am 1997, 8:11~29
15)周东,李昭林,林志俊,等.神经内镜辅助的中后颅窝胆脂瘤显微手术治疗[J].中国耳鼻喉颅底外科杂志, 2002,8(2): 73~75
16)张亚卓,王忠诚,刘丕楠,等.神经内镜辅助显微外科治疗颅内胆脂瘤[J].中华神经外科杂志, 2001,17(4): 201~204
17) Talagiba M, Matthies C, Samii M.Microendoscopy of the internal auditory canal in vestibular schwannoma surgery [J]. Neurosurgery, 1996, 38:737~740
18) Mitsuoka H, Arai H, Tsunoda A, et al. Microanatomy of the cerebellopontine angle and internal auditory canal: Study with new magnetic resonance imaging technique using three-dimensional fast spin echo [J]. Neurosurgery, 1999,44:561~567
19) Fries G, Perneczky A. Endoscope-assisted brain surgery: Part 2-Analysis of 380 procedures [J]. Neurosurgery, 1998, 42:226~232
20) Magnan J, Chays A, Lepetre C, et al. Surgical perspectives of endoscopy of the cerebellopontine angle [J].Am J Oto1, 1994, 15:366~370
21) Matula C, Diaz Day J, Czech T. The retrosigmoid approach to acoustic neurinomas:Technical,strategic,and firture concepts [J]. Acta Neurochir (Wien), 1995, 134 (3~4): 139~147
22) King WA, Wackym PA. Endoscope-assisted surgery for acoustic neuromas:Early experience using the rigid Hopkins telescope [J]. Neurosurgery, 1999, 44 (5): 1095~1102
23)廖建春,朱杭军,丁学华,等.内耳门周结构对内镜下脑桥小脑三角区手术的影响[J].中国临床解剖学杂志,2003 , 21 (5) : 443～444
24)陈立华.刘运生,方加胜,等.听神经瘤枕下乙状窦后锁孔入路的临床探讨[J],中国耳鼻咽喉颅底外科杂志,2002 , 8(1):11～14
25) Valtonen HJ, Poe DS, Heilman CB. Endoscopically assisted prevention of cerebrospinal fluid leak in suboccipital acoustic neuromas surgery [J]. Am J Otol, 1997, 18: 381~385
26) Kim HN, Kim YH, Park IY,et al. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle[J]. Ann Otol Rhinol Laryngol. 1990 Apr; 99(4 Pt 1):288~96.
1) Hardy J. Microneurosurgery of the hypophysis: a subnasal transsphenoidal approach with television magnification and televised radiofluoroscopic control. In: Rand RW, editor. Microneurosurgery. St. Louis (MO): CV Mosby; 1969. p. 87–103
2) Guiot G. Transsphenoidal approach in surgical treatment of pituitary adenomas: general principles and indications in non-functioning adenomas. In: Kohler PO, Ross GT, editors. Diagnosis and treatment of pituitary tumors. Amsterdam: Series No. 303, Excerpta Medica, International Congress; 1973. p. 159–178
3)李龄.经口鼻蝶入路的垂体腺瘤切除术。同济医科大学学报1987;5:338-340
4)雷霆,舒凯,胡文安,等。经鼻蝶入路显微切除大和巨大型垂体腺瘤。中国临床神经外科杂志2000;5:202-203
5) Fahlbusch R, Buchfelder M: The transsphenoidal approach to invasive sellar and clival lesions, in: Sekhar LM, Janecka IP (eds.) Surgery of cranial base tumors. Raven Press, New York 1993, pp. 337-349
6) Fahlbusch R, Buchfelder M: Surgical complications, in: Landolt AM, Vance ML, Reilly PL(eds.) Pituitary adenomas. Churchill Livingstone, New York 1996, pp:395-408
7) Buchfelder M.垂体腺瘤。德国医学1999;16:312
8) Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery. Laryngoscope 1992;102:198–202
9) Jho HD.Endoscopic endonasal pituitary surgery: Technical aspects. Contemp Neurosurg,19976:1-7
10) Jho HD,Carrau RL.Endoscopic endonasal transsphenoidal surgery: Experience with 50 patients. J Neurosurg,1997,87:44-51
11)舒凯,雷霆,厉春玲等.老年垂体腺瘤患者围手术期处理.中华老年多器官疾病研究杂志, 2002,1(2):127
12)雷霆,舒凯,胡文安.经鼻蝶入路显微手术修补床突-斜坡部缺损所致脑脊液鼻漏[J].中国微侵袭神经外科杂志,2000,5(1):46-47
13) Fahlbusch R, Honegger J, Buchfelder M: Transsphenoidal microsurgery for craniopharyngioma, in: Schmidek HH, Sweet WH(eds.) Operative neurosurgical techniques. W.B. Saunders, Philadelphia 1995, pp:371-379
14) (德)Axel Perneczky,et al著,孙维群等译.神经外科锁孔手术-内窥镜辅助的显微外科及典型病例,济南:山东科学技术出版社,2001,35-38
15)王忠诚,张亚卓.微侵袭内镜神经外科的现状与展望.中华神经外科杂志,2001,17:199-200
16) Rodziewicz GS,Kellman RM,et al.Transnasal Endoscopic surgery of the pituitary gland:technique note. Neurosurgery,1996,39:189-193
17)刘丕楠,张亚卓,艾林,等.内窥镜下经鼻腔-蝶窦入路切除垂体腺瘤的解剖学研究[J].中华神经外科杂志,2000,16(1):16-8
18)张亚卓主编.神经内镜手术技术,北京:北京大学医学出版社,2004,56-59
19)王志潮,丁学华.内窥镜下经鼻蝶切除垂体瘤手术中蝶鞍的解剖定位[J].中国临床解剖学杂志,2003,21(5):421-3
20) Sethi DS, Stanley RE. Endoscopic anatomy of the sphenoid sinus and sella turcica. J Laryngol Otol 1995; 109:951–5
21) Cappabianca P,Alfieri A. Endoscopic transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery. Minimin Invas Neurosurg,1998,41: 66-73
22) Sethi DS, Pillay PK. Endoscopic pituitary surgery- a minimally invasive technique. Am J Rhinol 1996;10:141–7
23) Perneczky A,Fries G. Endoscope-assisted brain surgery: Part 1-erolution, basic concept, and curret technique. Neurosurgery,1998,42:219-225
24) Carrau RL.Jho HD,Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland.Laryngoscope,1996,106:914-918
25) Ciric I, Ragin A, Baumgartner C, et al. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery, 1997 ;40(2):225-236
26) Cappabianca P, Cavallo LM, Colao A, et al.Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas.J Neurosurg.,2002 ;97(2):293-298
27) Nasseri SS, Kasperbauer JL, Strome SE, et al. Endoscopic transnasal pituitary surgery: report on 180 cases. Am J Rhinol 2001;15:281–7
28)刘承基.微侵袭神经外科的过去、现在和展望.中华神经外科杂志,2001,17:262-264
29)张亚卓,王忠诚,高鲜红.神经内镜技术的临床应用.中华神经外科杂志,2000,16:3-7
30) Meij BP, Lopes MB, Ellegala DB, et al. The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery. J Neurosurg. 2002; 96:195-208
31) Jame JA, Thapar K, Kaptain GJ, et al. Pituitary surgery: transsphenoidalapproach. Neurosurgery 2002;51:435–442
32)杜固宏,毛颖,等.神经导航在垂体瘤显微手术中的的应用.中国微侵袭神经外科杂志,2001 6(2) 65-68
33) Elias W J, Chadduck J B, Alden T D,et al. Framelessstereotaxy for transsphenoidal surgery[J]. Neurosurgery,1999,45(2):271-275.
34)杜固宏,周良辅。神经导航在神经外科手术中的应用。中国神经临床外科杂志,2000
35)王安睿,石全红,支兴刚。术中MRI的应用现状与展望[J].国外医学神经病学神经外科学分册,2002,29:1-3
36) Wirtz CR, Bonsanto M, Knauth M M, et al.Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: Method and preliminary experience. Comp Aid Surg 1997,2:172-179
37) Bohinski R J, Warnick RE, Gaskill-Shipley MF, et al. Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery, 2001, 49: 1133-1143.
1) Hopf NJ, Perneczky: A Endoscopic Neuosurgery and Endoscope assisted Micro neurosurgery for the treatment of intracranial Cysts. Neurosurgery, 1998, 43: 1330-1336
2) Schroeder HW, Oertel J, Gaab MR.: Incidence of complications in neuroendoscopic surgery. Childs Nerv Syst. 2004,20:11-12
3) Perneczky A,Fries G.: Endoscope-assisted Brain Surgery Part 1-Evolution, Basic Concept, and Current Technique. Neurosurgery,1998,42:219-224
4) Grotenhuis JA: Endoscope-assisted craniotomy, in Techniques in Neurosurgery. Philadelphia, Lippincott-Raven Publishers, 1996, vol 1, no 3, pp 201-212
5) MacKay CI,Baeesa SS,Ventureyra ECG: Epidermoid cyst of the pineal region. Child NERV Syst ,1999,15:170-178
6) De la Cruz A,Doyle KJ: Epidrmoid cyst of the cerebellopontine angle. In Jackler RK,Brackmann DE(eds):Neurotology,New York,Mosby,1994:823-834
7) Samii M,Tatagiba M,Piguer J,et al:Surgical treatment of epidrmoid cyst of the cerebellopontine angle. J Neurosurgery,1996,84:14-19
8) Netsky MG: Epidermoid cyst.Review of the literature. Surg Neurol, 1988,29:477-83
9)张亚卓,王忠诚,刘丕楠,等:神经内镜辅助显微外科治疗颅内胆脂瘤.中华神经外科杂志,2001 ,17:201 2 204
10)王忠诚.王忠诚神经外科学.第2版.湖北科学技术出版社.武汉2000
11) Matthieu V, Bruno P, Lejeune JP, et al. Intradural epidermoid cyst of the cerebello-pontine angle: diagnosis and surgery. Neurosurgery , 1995, 36: 52-57
12) Pampliega-Perez A, Martin-Estefania C, Caballe-Tura M,et al: Aseptic meningitis caused by the rupture of an epidermoid cyst. Rev Neurol. 2003 Aug 1-15;37(3):221-4.
1. Walker ML. History of ventriculostomy [J]. Neurosurg Clin N Am, 2001, 12: 101-110
2. Dandy WE. An operative procedure for hydrocephalus [J]. Johns Hopkins Hosp Bull, 1922, 33: 189-190
3. Fay T, Grant F. Ventriculostomy and intraventricular photography in internal hydrocephalus [J]. JAMA, 1923, 80: 461-463
4. Abbott R. History of neuroendoscopy [J]. Neurosurg Clin N Am, 2004, 15: 1-7
5. Putnam T. Treatment of hydrocephalus by endoscopic coagulation of the choroid plexus [J]. N Engl J Med, 1934, 10: 1373-1376
6. Scarff JE. Endoscopic treatment of hydrocephalus: Description of a ventriculoscopes and preliminary report of cases [J]. Arch Neurol Psychiatry, 1935, 35: 853-861
7. Nulsen FE, Spitz EB. Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surgical Forum, 1952, 2: 399-403
8. Jacobson JH II, Wallman LJ, Schumacher GA, et al. Microsurgery as an aid to middle cerebral artery endarterectomy [J]. J Neurosurg, 1962, 19: 108-115
9. Sargil MG. A legacy of microneurosurgery: memoirs, lessons, and axioms [J]. Neurosurgery, 1999, 45: 1025-1092
10. Apuzzo MLJ, Heifetz MD, Weiss MH, et al. Neurosurgical endoscopy using the side-viewing telescope [J]. J Neurosurg, 1977, 46: 398-400
11. Boyle WS, Smith GE. Inception of charge-coupled devices [J]. IEEE Transact Elect Dev, 1976, 23: 661-663
12. Gerzeny M, Cohen AR. Advances in endoscopic neurosurgery [J]. AORN J, 1998, 67(5): 957-961, 963-965
13. Hopf NJ, Pemeczky A. Endoscopic neurosurgery and endoscope assisted microneurosurgery for the treatment of intracranial cysts [J]. Neruosurgery, 1998, 43: 1330-1337
14. Hayashi N, et al. clinical features in patients requiring reoperation after failed endoscopic procedures for hydrocephalus [J]. minim invasive neurosurg, 2000, 43: 181-186
15.詹升全,林志俊,李绍杰,等.神经内窥镜手术治疗小儿脑积水[J].中华神经外科杂志, 2000, 16: 14-15
16. Gangemi M, et al. Endoscipic third ventriculostomy for hydrocephalus [J]. Minim Invasive Neurosurg, 1999, 42(3): 128-132
17. Strowitzki M, Kiefer M, Steuedl W. A new method of ultrasonic guidance of neuroendoscopic procedures technical nete [J]. J Neurosurg, 2002, 96(3): 628-632
18.孟辉,冯华.神经内镜在神经外科的临床应用进展[J].四川医学, 2002, 6: 636-638
19. Seeger W. Microsurgery of the brain [J]. wein: Springer Verlag, 1980, 46-53
20. Horvath Z, et al. Biportal endoscopic removal of a primary interventricular hematoma: case report [J]. Minim Invasive Neurosury, 2000, 43: 4-8
21. Auer M, Deinsberger W, Niederkem, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: A randomized study [J]. JNeurosurg, 1989, 70: 530-535
22. Hellwig D, Kuhn TJ, Bauer BL, et al. Endoscopic treatment of septated chronic subdural hematoma [J]. Surg Neurol, 1996, 45(3): 272-277
23. Hopf NJ. Endoscopic neurosurgery "around the corner" with rigid endoscope technical note [J]. Minim Invasive Neurosurg, 1999, 42(1): 27-31
24. Barajas Ma, Ramirez-Guzmun G, et al. Multimodal management of craniopharyngiomas: neuroendoscopy, microsurgery, and radiosurgery [J]. J Neurosury, 2002, 97(5 suppl): 607-609
25. Taniguchi M, et al. Application of a rigid endoscope to the micro-surgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosury, 1999, 91(2); 231-237
26. Alfieri A. Endoscopic endonasal transsphenoidal approach to the sellar region: technical evolution of the methodology and refinement of a dedicated instrumentation [J]. J Neurosurgy Sci, 1999, 43(2): 85-92
27. Jho HD, et al. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations [J]. Minim Invasive Neurosurg, 2001, 44: 1-12
28. Kato Y, et al. Endoscope-assisted microsurgery for cerebral aneurysms [J]. Minim Invasive Neurosurg, 2000, 43: 91-97
29. Gangemi M, et al .Endoscopic surgery for pineal region tumors [J]. Minim Invasive Neurosurg, 2001, 44: 70-73
30.刘丕楠,王忠诚,张亚卓,等.内镜下经鼻腔-蝶窦入路垂体腺瘤切除术[J].中华神经外科杂志, 2001, 17: 220-222
31.张亚卓,王忠诚,高鲜红,等.神经内镜手术并发症及防治[J].中华神经外科杂志, 2003, 19: 405-406
32. Fabnegas N, Lopez A, Valem R, et al .Anesthetic management of surgical neuroendoscopic usefulless of monitoring the pressure inside the meuroendoscope [J]. J Neurosurg, 2002, 12: 21-28
33. Oka K, Go Y, Yamamoto M, et al. Experience with an ultrasonic aspirator in neuroendoscopy [J]. Minim Invasive Neurosurg, 1999, 42(1): 32-34
34. Qiu Y, Lin Y, Pang Y, et al. Bipolar microscissors [J]. Minim Invasive Neurosurg, 2004, 47(5): 316-318
35. Willems PW, Vandertop WP, Verdaasdonk RM, et al. Contact laser-assisted neuroendoscopy can be performed safely by using pretreated 'black' fibre tips: experimental data [J]. Lasers Surg Med, 2001, 28(4): 324-329
36. Tirakotai W, Bozinov O, Sure U, et al. The evolution of stereotactic guidance in neuroendoscopy [J]. Childs Nerv Syst, 2004, 20(11-12): 790-795
37. Resch KD. Endo-neuro-sonography: first clinical series (52 cases) [J]. Childs Nerv Syst, 2003, 19(3): 137-144
38. Chen JC, Levy ML, Corber Z, et al. Concurrent three dimensional neuroendoscopy: initial descriptions of application to clinical practice [J]. Neurosurg Focus, 1999, 15:64-72
39. Aryan HE, Hoeg HD, Marshall LF, et al. Multidirectional projectional rigid neuro-endoscopy: prototype and initial experience [J]. Minim Invasive Neurosurg, 2005, 48(5): 293-296
40. Nguyen A, Aryan H, Jandial R, et al. Robotic virtual endoscopy: development of a multidirectional rigid endoscope [J]. Neurosurgery, 2006, 59: 134-141
41.詹升全,李昭杰,林志俊,等.神经内镜在脑外科的临床应用[J].中华外科杂志, 2002, 40: 187-190
42.王忠诚,张亚卓.微侵袭内镜神经外科的现状和展望[J].中华神经外科杂志, 2001, 17: 199-200
2) Cohen A R, Perneczky A, Rodziewicz G S, et al. Endoscope–assisted craniotomy: Approach to the rostral brain stem [J]. Neurosurgery, 1995, 36 (6): 1128-1130
3) Czirjak S, Szeifert G. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision [J]. Neurosurgery, 2001, 48(1): 145-150
4) Fries G, Perneczky A, von Lindert E, et al. Contra lateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysm [J]. Neusurgery, 1997, 41(2): 333-343
5) Hiroyuki Kinouchi, Katsuya Futawatari, Kazou Mizoi, et al. Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process [J]. J Neurosurg, 2002, 96(4): 788-791
6) Perneczky A, Fries G. Endoscope-assisted brain surgery: Part1-Evolution, basicconcept, and current technique [J]. Neurosurgery, 1998, 42(2): 219-225
7) Taniguchi M, Takimoto H, Yoshimine T, et al. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosurg, 1999, 91(2): 231-237
8) Hiroyuki Kinouchi, Katsuya Futawatari, Kazou Mizoi, et al. Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process. J Neurosurg, 2002, 96(4): 788-791
9) De Oliveira E, Tedeschi H, Siqueira MG, et al. Anatomical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir (wien), 1996, 138: 1-11
10) Perneczky A,Boecher Schwarz HG.. Endoscope-assisted microsurgery for cerebral aneurysms [J]. Neurol Med Chir Tokyo, 1998, 38 Suppl: 33-34
11) Fries G, Perneczky A, von Lindert E, et al. Contra lateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysm [J]. Neurosurgery, 1997, 41(2): 333-343
12) Taniguchi M, Takimoto H, Yoshimine T, et al. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosurg, 1999, 91(2): 231-237
13) Steiger HJ, Schmid-Elsaesser R, stummer W, et al. Transorbital keyhole approach to anterior communicating artery aneurysms [J]. Neurosurgery, 2001, 48: 347-351
14) Yasargil. General operative techniques. In: Yasargil MG, ed. Microneurosurgery. Vo l. New York: Georg Thieme Verlag Stutzgur, 1984. 208-71
15) Cohen A R, Perneczky A, Rodziewicz G S, et al. Endoscope-assisted craniotomy: Approache to the rostral brain stem. Neurosurgery, 1995, 36(6): 1128-1130
16) Menovsky T,Grotenhuis JA,de Vries J , et al. Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa [J]. Neurosurgery, 1999, 44(1): 106-110
17) Kim M H,Jho H D. Endoscopic reverse third ventriculostomy via the cisterna magna: anatomical study and proposal of a novel procedure [J]. Minim Invasive Neurosurg, 2002, 45(2): 84-86
18) Fries G, Perneczky A. Endoscope-assisted brain surgery: Part 2-analysis of 380 procedures [J]. Neurosurgery, 1998, 42(2): 226-232
19) Tamaki N, Hara Y, Takaishi Y, et al. Angled rigid neuroendoscope for continuous intraoperative visual monitoring: technical note [J]. J Clin Neurosci, 2001, 8(2): 148-150
20) King WA, Wackym PA. Endoscope-assisted surgery for acoustic neuromas (vestibular schwannomas): Early experience using the Rigid Hopkins telescope [J]. Neurosurgery, 1999, 44(5): 1095-1100
21) Kalavakonda C, Laligam N. Sekhar, Ramachandran P, et al. Endoscope-assisted microsurgery for intracranial aneurysms [J]. Neurosurgery, 2002, 51: 1119-1125
22)丰育功,朱贤立,张俊亭,等.经翼点入路鞍区手术间隙的显微解剖研究[J].中华神经外科杂志, 2000, 16(4): 222-225
23) Cohen A R, Perneczky A, Rodziewicz G S, et al. Endoscope-assisted craniotomy: Approache to the rostral brain stem [J]. Neurosurgery, 1995, 36(6): 1128-1130
24) Czirjak S, Szeifert G. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision [J]. Neurosurgery, 2001, 48(1): 145-150
25) Fries G, Perneczky A, von Lindert E, et al. Contra lateral and ipsilateral microsurgical approaches to carotid - ophthalmic aneurysm [J]. Neusurgery, 1997, 41(2): 333-343
26) Hiroyuki Kinouchi, Katsuya Futawatari, Kazou Mizoi, et al. Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process [J]. J Neurosurg, 2002, 96(4): 788-791
27) Perneczky A, Fries G. Endoscope-assisted brain surgery: Part1-Evolution, basic concept, and current technique [J]. Neurosurgery, 1998, 42(2): 219-225
28) Taniguchi M, Takimoto H, Yoshimine T, et al. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosurg, 1999, 91(2): 231-237
29)凌锋译.显微神经外科学[M].北京:中国科学技术出版社, 2001, 209– 227
30)吴建东,惠国桢,夏春林,等.垂体上动脉显微外科解剖学研究[J].中华神经外科杂志, 2000, 16: 146-148
31) Guilio M, Carmilo A, Cesare C, et al. Craniopharyngiomas of the third ventricle: trans - lamina terminalis approach [J]. Neurosurgery, 2000, 47(4): 857-865
32)夏春林,惠国桢. Willis氏环前部与前交通动脉瘤相关的显微解剖研究[J].中华神经外科杂志, 1991, 7: 255-258
1) Jho HD, Alfieri A. Endoscopic Endonasal Pituitary Surgery: Evolution of Surgical Technique and Equipmeng in 150 Operations [J]. Minim Invas Neurosurg, 2001,44(l): l-12
2) Jho HD, Alfieri A. Endoscopic transsphenoidal pituitary: various surgical techniques and recommended steps for procedural transition [J]. Br J Neurosurg, 2000, 14(5): 432-440
3) Carl B H, William A S, Elie E R. Endoscopic Sphenoidotomy Approach to the Sella [J]. Neurosurgery, 1997, 41(3): 602-607
4)王忠诚.神经外科临床解剖学[M].山东:山东科学技术出版社, 2001, 101-105
5)周定标.颅底肿瘤手术学[M].北京:人民军医出版社, 1997, 313-316
6)廖建春,陈菊祥,王海青,等.蝶窦的影象解剖学研究[J].中国临床解剖学杂志, 1999, 17(4): 309-311
7)范静平,廖建春,吴建,等.内窥镜蝶窦及鞍区手术应用解剖学研究[J].中国临床解剖学杂志, 1996, 14(2): 95-98
8)陶海,马志中,姜荔.视神经管的显微解剖及临床意义[J].中国临床解剖学杂志, 2000, 18(4): 296-298
9)范建平,章松勤,廖建春,等.内窥镜视神经管减压术应用解剖[J].中国临床解剖学杂志, 1996, 14(2): 92-94
10)张亚卓,王忠诚,等.神经内窥镜技术的临床应用[J].中华神经外科杂志, 2000, 16(1): 3-7
11)蔡瑜综述.内窥镜技术在经蝶垂体瘤手术中的运用进展[J].国外医学神经病学神经外科学分册, 1998, 25(5): 240-242
12) Jarrahy, Yi Min Suh, et al. Endoscopic pituitary: an in vivo model for transnasal transsphenoid hypophysectomy [J]. J Laparoendosc Adv Surg Tech A, 1999, 9(2): 211-219
13) Jho HD, Ricardo L, Carrau. Endoscopic Endonasal Transspenoidal Surgery: Experience with 50 patients [J]. Neurosurg, 1997, 7(87): 44-51
14) Yamv E, Rappaport ZH. Endoscopic Transseptal Transsphenoidal Surgery for pituitary tumors [J]. Neurosurgery, 1997, 5(40): 944-946
15)魏少波,周定标,张纪,等.经单鼻孔蝶窦入路切除垂体肿瘤.中国微侵袭神经外科杂志, 2001, 6: 72-75
16)孙炜,庞琦,张庆林,等.经单侧鼻腔一蝶窦入路切除垂体腺瘤[J].中国微侵袭神经外科杂志, 2001, 9: 76-78
17)廖建春,吕春雷,王海青,等.最后筛房的影像解剖学研究[J].中国临床解剖学杂志, 1999, 17(4): 298-299
18)史剑波,许庚,徐锦堂,等.经鼻内窥镜视神经管减压术的解剖和临床研究[J].中国内镜杂志, 1997, 3(5): 13-15
19)孙敬武,王银凤,陈晓虹,等.经鼻内窥镜蝶窦鞍区手术解剖及临床应用[J].中国临床解剖学杂志, 2000, 18(3): 199-200
1) Perneczky A, Muller-Forell W, van Lindert E, et al. Keyhole concept in neurosurgery: with endoscope-assisted microsurgery and case studies [M]. New York: Thieme, 1999: 1-100
2)王忠诚.神经外科学[M].湖北,湖北科学技术出版社. 1998. 154-155
3)张亚卓,等.脑室外科手术学[M].北京,中国协和医科大学出版社. 2001. 169-171
4)张亚卓,王忠诚,等.神经内窥镜技术的临床应用[J].中华神经外科杂志, 2000, 16(1): 3-7
5)高鲜红,何乐,张亚卓,等.侧脑室、三脑室神经内镜应用解剖[J].中华神经外科杂志, 2001, 17(4): 223-226
6)周庭永,韩景茹,马贻玲.侧脑室的横断面解剖学研究[J].解剖学杂志, 1997, 20(3): 289-292
7)陈谦学,郑晓华,刘仁忠.成人侧脑室正常值的测定及其临床意义[J].湖北医科大学学报, 1996, 17(4): 365-366
8)陆生九,狄荣科,刘益仁,等.室间孔的形态学研究[J].解剖学杂志, 1996, 19(1): 4-7
9)唐勇,母其文,陈联盟.人体侧脑室容量年龄变化的研究[J].解剖学杂志, 1995, 18(2): 108-110
10)郭宇,李幼琼.侧脑室的医学三维重建研究[J].解剖科学进展, 1999, 5(3): 276-279
11)高振平,吕衡发,李幼琼,等.侧脑室三维断层影像解剖学应用研究[J].解剖学杂志, 1998, 27(4): 62-65
12)李幼琼,张立忠,王野成.侧脑室的三维重建及应用研究[J].解剖学杂志, 2000, 23(22): 85-86
13)王可人,郭京丽,鲁澄宇,等.侧脑室计算机三维重建及理论分析[J].白求恩医科大学学报, 2001, 27(4): 344-346
14)李幼琼,王可人,董国军,等.侧脑室三维重建及立体观测[J].第四军医大学吉林军医学院学报, 2001, 23(2): 94-95
15)刘正清,文小丹,彭光春,等.正常中老年人活体侧脑室容量的CT测量[J].解剖学研究, 2001, 23(3): 222-223
16)亢建民,梁恩和,姚鑫,等.改良的成人脑室额角穿刺定位术[J].天津医药, 2001, 29(12): 722-723
17) Natori Y, Fukui M, Rhoton A L. Anterior interhemispheric transcallosal approach for lateral ventricle lesions [J]. No Shinkei Geka, 1997, 25(9): 777-784
18) Switka A, Narkiewicz O, Dziewiatkowski J, et al. The shape of the inferior horn of the lateral ventricle in relation to collateral and occipitotemporal sulci [J]. Folia Morphol (Warsz), 1999, 58(2): 69-80
19) Mu Q, Xie J, Wen Z, et al. A quantitative MR study of the hippocampal formation, the amygdala, and the temporal horn of the lateral ventricle in healthy subjects 40 to 90 years of age [J]. Am J Neuroradiol, 1999, 20(2): 207-211
1) Decq P, Le Guerinel C, Sol J C, etl. Endoscopic anatomy of the third ventricle [J]. Neurochirurgie, 2000, 46(3): 203-208
2)万经海.内窥镜神经解剖学[J].微侵袭神经外科杂志, 1997, 2(3): 215-217
3)高鲜红,何乐,张亚卓.侧脑室、三脑室神经内镜应用解剖[J].中华神经外科杂志, 2001, 17(4): 223-226
4)雷小环,等.第三脑室的显微外科解剖[J].中国神经精神病杂志, 1986, 12(6): 321-325
5)马廉亭.微侵袭神经外科学[M].北京:人民军医出版社. 1999, 508-512
6)张亚卓,刘恩重,等.脑室外科手术学[M].北京:中国协和医科大学出版社, 2001. 46-50
7)李幼琼,高振平,王晓慧.第三脑室三维断层影像解剖学及其临床意义[J].中国临床解剖学杂志, 1999, 17(1): 39-40
8)李幼琼,高振平,吕衡发.第三脑室三维断层影像解剖学研究[J].解剖学杂志, 1998, 21: 62-65
9)李幼琼,高振平,苏略.第三脑室区域的显微断层解剖学研究[J].长春中医学院学报, 1998, 14(4): 34-37
10)韩文江.第三脑室的显微外科解剖[J].论文汇编, 1988, 6: 90-93
11)何润昌.第三脑室后部显微外科解剖[J].中华神经外科杂志, 1986, 3:159-164
12)钱学华,姜均本.人脑松果体区域的断面解剖学研究[J].解剖学报, 1995, 26(4): 337-340
13)王海杰.中间块的观察和测量[J].解剖学杂志, 1992, 2: 140-143
14)陆生九,狄荣科,刘益仁.室间孔的形态学研究[J].解剖学杂志, 1996, 19(1): 4-7
15)宋鹤九,陈玉敏,常义.在前连合前,脱服体梯度坐标值的解剖定位[J].功能性和立体定向神经外科杂志, 1995, 8(4): 1-3
16)傅先明.三脑室宽度和内囊位置的关系[J].功能性和立体定向神经外科杂志, 1991, (2): 8-9
17) Nikolai J H, Peter G, Georg F.经内窥镜的第三脑室切开术((ETV): 100例分析[J].德国医学, 1999, 16(6): 325-327
18) Okamoto S, Narumi O. Operative approaches to tumors in and around the anterior half of the third ventricle [J]. No Shinkei Geka, 2002, 30(9): 923-932
19) Wen H T, Rhoton A L, De Oliveira E. Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application [J]. Neurosurgery, 1998, 42(6): 1205-1217
20) Winkler P A, Weis S, Buttner A, et al. The transcallosal interforniceal approach to the third ventricle: anatomic and microsurgical aspects [J]. Neurosurgery, 1997, 40(5): 973-982
21) Iordachescu A, Ianovici N. Tumors of the third ventricle. Rev Med Chir Soc Med Nat Iasi, 1997, 101(3-4): 145-151
1) O'Donoghue GM, O'Flynn P. Endoscopic anatomy of the cerebellopontine [J]. Am J Otology, 1993; 14(2):122~125
2) Rhoton AL Jr. The posterior cranial fossa: microsurgical anatomy and surgical approaches [J]. Neurosurgery, 2000, 47(Suppl3): 129-130
3) Lister J, Rhoton AL Jr, Matsushima T, et al. Microsurgical anatomy of the posterior inferior cerebellar artery [J]. Neurosurg, 1982; 10(2): 170~199
4) Salas E, Ziyal IM, Bank WO, et al. Extradural origin of the posteroinferior cerebellar artery: an anatomic correlation [J]. Neurosurg, 1998; 42(6): 1326~1331
5) Fine A, Cardoso A, Rhoton AL. Microsurgical anatomy of the extracranial-extradural origin of the posterior inferior cerebellar artery [J]. J Neurosurg, 1999; 91(4): 645~652
6) Goksu N, Bayazit Y, Kemaloglu Y. Endoscopy of the posterior fossa and dissection of acoustic ncuroma. J Neurosurg, 1999, 91(5):776-780
7) Tatagiba M, Samii M, Matthies C, et al. The significance for postoperative hearing of preserving the labyrinth in acoustic neurinoma surgery[J]. J neurosurg 77:677~684, 1992
8) C.Matula, J.Diaz Day, T.Czech, et al. The Retrosigmoid Approach to Acoustic Neurinomas: Technical, Strategic, and Future Concepts [J]. Acta Neurochir (Wien), 1995, 134; 139~147
9)江涛,王忠诚,于春江等.单侧枕下乙状窦后入路磨开内耳道后壁与骨迷路保护[J].中华神经外科杂志,1999,15(4):196~199
10) King WA, Wackym PA, Sen C, et al. Adjunctive us of endoscopy during posterior fossa surgery to treat cranial neuropathies [J]. Neurosurgery, 2001; 49(1):108~116
11) Janetta PJ. Neurovascular vompression in cranial nerve and systemic disease. Ann Surg, 1980, 192: 518~525
12) Huang CI, Chen IH, Lee LS: Microvascular decompression for hemifacial spasm: Analysis of operative findings and results in 310 patients. Neurosurgery 1992,30:53～57
13) Jannetta PJ: Treatment of trigeminal neuralgia by micro operative decompression, in Youmans JR (ed): Neurological Surgery. Philadelphia, W. B. Saunders Co., 1996, pp 3589~3603
14) Lovely TJ, Jannetta PJ: Microvascular decompression for trigeminal neuralgia: Surgical technique and long~term results. Neurosurg Clin N Am 1997, 8:11~29
15)周东,李昭林,林志俊,等.神经内镜辅助的中后颅窝胆脂瘤显微手术治疗[J].中国耳鼻喉颅底外科杂志, 2002,8(2): 73~75
16)张亚卓,王忠诚,刘丕楠,等.神经内镜辅助显微外科治疗颅内胆脂瘤[J].中华神经外科杂志, 2001,17(4): 201~204
17) Talagiba M, Matthies C, Samii M.Microendoscopy of the internal auditory canal in vestibular schwannoma surgery [J]. Neurosurgery, 1996, 38:737~740
18) Mitsuoka H, Arai H, Tsunoda A, et al. Microanatomy of the cerebellopontine angle and internal auditory canal: Study with new magnetic resonance imaging technique using three-dimensional fast spin echo [J]. Neurosurgery, 1999,44:561~567
19) Fries G, Perneczky A. Endoscope-assisted brain surgery: Part 2-Analysis of 380 procedures [J]. Neurosurgery, 1998, 42:226~232
20) Magnan J, Chays A, Lepetre C, et al. Surgical perspectives of endoscopy of the cerebellopontine angle [J].Am J Oto1, 1994, 15:366~370
21) Matula C, Diaz Day J, Czech T. The retrosigmoid approach to acoustic neurinomas:Technical,strategic,and firture concepts [J]. Acta Neurochir (Wien), 1995, 134 (3~4): 139~147
22) King WA, Wackym PA. Endoscope-assisted surgery for acoustic neuromas:Early experience using the rigid Hopkins telescope [J]. Neurosurgery, 1999, 44 (5): 1095~1102
23)廖建春,朱杭军,丁学华,等.内耳门周结构对内镜下脑桥小脑三角区手术的影响[J].中国临床解剖学杂志,2003 , 21 (5) : 443～444
24)陈立华.刘运生,方加胜,等.听神经瘤枕下乙状窦后锁孔入路的临床探讨[J],中国耳鼻咽喉颅底外科杂志,2002 , 8(1):11～14
25) Valtonen HJ, Poe DS, Heilman CB. Endoscopically assisted prevention of cerebrospinal fluid leak in suboccipital acoustic neuromas surgery [J]. Am J Otol, 1997, 18: 381~385
26) Kim HN, Kim YH, Park IY,et al. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle[J]. Ann Otol Rhinol Laryngol. 1990 Apr; 99(4 Pt 1):288~96.
1) Hardy J. Microneurosurgery of the hypophysis: a subnasal transsphenoidal approach with television magnification and televised radiofluoroscopic control. In: Rand RW, editor. Microneurosurgery. St. Louis (MO): CV Mosby; 1969. p. 87–103
2) Guiot G. Transsphenoidal approach in surgical treatment of pituitary adenomas: general principles and indications in non-functioning adenomas. In: Kohler PO, Ross GT, editors. Diagnosis and treatment of pituitary tumors. Amsterdam: Series No. 303, Excerpta Medica, International Congress; 1973. p. 159–178
3)李龄.经口鼻蝶入路的垂体腺瘤切除术。同济医科大学学报1987;5:338-340
4)雷霆,舒凯,胡文安,等。经鼻蝶入路显微切除大和巨大型垂体腺瘤。中国临床神经外科杂志2000;5:202-203
5) Fahlbusch R, Buchfelder M: The transsphenoidal approach to invasive sellar and clival lesions, in: Sekhar LM, Janecka IP (eds.) Surgery of cranial base tumors. Raven Press, New York 1993, pp. 337-349
6) Fahlbusch R, Buchfelder M: Surgical complications, in: Landolt AM, Vance ML, Reilly PL(eds.) Pituitary adenomas. Churchill Livingstone, New York 1996, pp:395-408
7) Buchfelder M.垂体腺瘤。德国医学1999;16:312
8) Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery. Laryngoscope 1992;102:198–202
9) Jho HD.Endoscopic endonasal pituitary surgery: Technical aspects. Contemp Neurosurg,19976:1-7
10) Jho HD,Carrau RL.Endoscopic endonasal transsphenoidal surgery: Experience with 50 patients. J Neurosurg,1997,87:44-51
11)舒凯,雷霆,厉春玲等.老年垂体腺瘤患者围手术期处理.中华老年多器官疾病研究杂志, 2002,1(2):127
12)雷霆,舒凯,胡文安.经鼻蝶入路显微手术修补床突-斜坡部缺损所致脑脊液鼻漏[J].中国微侵袭神经外科杂志,2000,5(1):46-47
13) Fahlbusch R, Honegger J, Buchfelder M: Transsphenoidal microsurgery for craniopharyngioma, in: Schmidek HH, Sweet WH(eds.) Operative neurosurgical techniques. W.B. Saunders, Philadelphia 1995, pp:371-379
14) (德)Axel Perneczky,et al著,孙维群等译.神经外科锁孔手术-内窥镜辅助的显微外科及典型病例,济南:山东科学技术出版社,2001,35-38
15)王忠诚,张亚卓.微侵袭内镜神经外科的现状与展望.中华神经外科杂志,2001,17:199-200
16) Rodziewicz GS,Kellman RM,et al.Transnasal Endoscopic surgery of the pituitary gland:technique note. Neurosurgery,1996,39:189-193
17)刘丕楠,张亚卓,艾林,等.内窥镜下经鼻腔-蝶窦入路切除垂体腺瘤的解剖学研究[J].中华神经外科杂志,2000,16(1):16-8
18)张亚卓主编.神经内镜手术技术,北京:北京大学医学出版社,2004,56-59
19)王志潮,丁学华.内窥镜下经鼻蝶切除垂体瘤手术中蝶鞍的解剖定位[J].中国临床解剖学杂志,2003,21(5):421-3
20) Sethi DS, Stanley RE. Endoscopic anatomy of the sphenoid sinus and sella turcica. J Laryngol Otol 1995; 109:951–5
21) Cappabianca P,Alfieri A. Endoscopic transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery. Minimin Invas Neurosurg,1998,41: 66-73
22) Sethi DS, Pillay PK. Endoscopic pituitary surgery- a minimally invasive technique. Am J Rhinol 1996;10:141–7
23) Perneczky A,Fries G. Endoscope-assisted brain surgery: Part 1-erolution, basic concept, and curret technique. Neurosurgery,1998,42:219-225
24) Carrau RL.Jho HD,Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland.Laryngoscope,1996,106:914-918
25) Ciric I, Ragin A, Baumgartner C, et al. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery, 1997 ;40(2):225-236
26) Cappabianca P, Cavallo LM, Colao A, et al.Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas.J Neurosurg.,2002 ;97(2):293-298
27) Nasseri SS, Kasperbauer JL, Strome SE, et al. Endoscopic transnasal pituitary surgery: report on 180 cases. Am J Rhinol 2001;15:281–7
28)刘承基.微侵袭神经外科的过去、现在和展望.中华神经外科杂志,2001,17:262-264
29)张亚卓,王忠诚,高鲜红.神经内镜技术的临床应用.中华神经外科杂志,2000,16:3-7
30) Meij BP, Lopes MB, Ellegala DB, et al. The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery. J Neurosurg. 2002; 96:195-208
31) Jame JA, Thapar K, Kaptain GJ, et al. Pituitary surgery: transsphenoidalapproach. Neurosurgery 2002;51:435–442
32)杜固宏,毛颖,等.神经导航在垂体瘤显微手术中的的应用.中国微侵袭神经外科杂志,2001 6(2) 65-68
33) Elias W J, Chadduck J B, Alden T D,et al. Framelessstereotaxy for transsphenoidal surgery[J]. Neurosurgery,1999,45(2):271-275.
34)杜固宏,周良辅。神经导航在神经外科手术中的应用。中国神经临床外科杂志,2000
35)王安睿,石全红,支兴刚。术中MRI的应用现状与展望[J].国外医学神经病学神经外科学分册,2002,29:1-3
36) Wirtz CR, Bonsanto M, Knauth M M, et al.Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: Method and preliminary experience. Comp Aid Surg 1997,2:172-179
37) Bohinski R J, Warnick RE, Gaskill-Shipley MF, et al. Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery, 2001, 49: 1133-1143.
1) Hopf NJ, Perneczky: A Endoscopic Neuosurgery and Endoscope assisted Micro neurosurgery for the treatment of intracranial Cysts. Neurosurgery, 1998, 43: 1330-1336
2) Schroeder HW, Oertel J, Gaab MR.: Incidence of complications in neuroendoscopic surgery. Childs Nerv Syst. 2004,20:11-12
3) Perneczky A,Fries G.: Endoscope-assisted Brain Surgery Part 1-Evolution, Basic Concept, and Current Technique. Neurosurgery,1998,42:219-224
4) Grotenhuis JA: Endoscope-assisted craniotomy, in Techniques in Neurosurgery. Philadelphia, Lippincott-Raven Publishers, 1996, vol 1, no 3, pp 201-212
5) MacKay CI,Baeesa SS,Ventureyra ECG: Epidermoid cyst of the pineal region. Child NERV Syst ,1999,15:170-178
6) De la Cruz A,Doyle KJ: Epidrmoid cyst of the cerebellopontine angle. In Jackler RK,Brackmann DE(eds):Neurotology,New York,Mosby,1994:823-834
7) Samii M,Tatagiba M,Piguer J,et al:Surgical treatment of epidrmoid cyst of the cerebellopontine angle. J Neurosurgery,1996,84:14-19
8) Netsky MG: Epidermoid cyst.Review of the literature. Surg Neurol, 1988,29:477-83
9)张亚卓,王忠诚,刘丕楠,等:神经内镜辅助显微外科治疗颅内胆脂瘤.中华神经外科杂志,2001 ,17:201 2 204
10)王忠诚.王忠诚神经外科学.第2版.湖北科学技术出版社.武汉2000
11) Matthieu V, Bruno P, Lejeune JP, et al. Intradural epidermoid cyst of the cerebello-pontine angle: diagnosis and surgery. Neurosurgery , 1995, 36: 52-57
12) Pampliega-Perez A, Martin-Estefania C, Caballe-Tura M,et al: Aseptic meningitis caused by the rupture of an epidermoid cyst. Rev Neurol. 2003 Aug 1-15;37(3):221-4.
1. Walker ML. History of ventriculostomy [J]. Neurosurg Clin N Am, 2001, 12: 101-110
2. Dandy WE. An operative procedure for hydrocephalus [J]. Johns Hopkins Hosp Bull, 1922, 33: 189-190
3. Fay T, Grant F. Ventriculostomy and intraventricular photography in internal hydrocephalus [J]. JAMA, 1923, 80: 461-463
4. Abbott R. History of neuroendoscopy [J]. Neurosurg Clin N Am, 2004, 15: 1-7
5. Putnam T. Treatment of hydrocephalus by endoscopic coagulation of the choroid plexus [J]. N Engl J Med, 1934, 10: 1373-1376
6. Scarff JE. Endoscopic treatment of hydrocephalus: Description of a ventriculoscopes and preliminary report of cases [J]. Arch Neurol Psychiatry, 1935, 35: 853-861
7. Nulsen FE, Spitz EB. Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surgical Forum, 1952, 2: 399-403
8. Jacobson JH II, Wallman LJ, Schumacher GA, et al. Microsurgery as an aid to middle cerebral artery endarterectomy [J]. J Neurosurg, 1962, 19: 108-115
9. Sargil MG. A legacy of microneurosurgery: memoirs, lessons, and axioms [J]. Neurosurgery, 1999, 45: 1025-1092
10. Apuzzo MLJ, Heifetz MD, Weiss MH, et al. Neurosurgical endoscopy using the side-viewing telescope [J]. J Neurosurg, 1977, 46: 398-400
11. Boyle WS, Smith GE. Inception of charge-coupled devices [J]. IEEE Transact Elect Dev, 1976, 23: 661-663
12. Gerzeny M, Cohen AR. Advances in endoscopic neurosurgery [J]. AORN J, 1998, 67(5): 957-961, 963-965
13. Hopf NJ, Pemeczky A. Endoscopic neurosurgery and endoscope assisted microneurosurgery for the treatment of intracranial cysts [J]. Neruosurgery, 1998, 43: 1330-1337
14. Hayashi N, et al. clinical features in patients requiring reoperation after failed endoscopic procedures for hydrocephalus [J]. minim invasive neurosurg, 2000, 43: 181-186
15.詹升全,林志俊,李绍杰,等.神经内窥镜手术治疗小儿脑积水[J].中华神经外科杂志, 2000, 16: 14-15
16. Gangemi M, et al. Endoscipic third ventriculostomy for hydrocephalus [J]. Minim Invasive Neurosurg, 1999, 42(3): 128-132
17. Strowitzki M, Kiefer M, Steuedl W. A new method of ultrasonic guidance of neuroendoscopic procedures technical nete [J]. J Neurosurg, 2002, 96(3): 628-632
18.孟辉,冯华.神经内镜在神经外科的临床应用进展[J].四川医学, 2002, 6: 636-638
19. Seeger W. Microsurgery of the brain [J]. wein: Springer Verlag, 1980, 46-53
20. Horvath Z, et al. Biportal endoscopic removal of a primary interventricular hematoma: case report [J]. Minim Invasive Neurosury, 2000, 43: 4-8
21. Auer M, Deinsberger W, Niederkem, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: A randomized study [J]. JNeurosurg, 1989, 70: 530-535
22. Hellwig D, Kuhn TJ, Bauer BL, et al. Endoscopic treatment of septated chronic subdural hematoma [J]. Surg Neurol, 1996, 45(3): 272-277
23. Hopf NJ. Endoscopic neurosurgery "around the corner" with rigid endoscope technical note [J]. Minim Invasive Neurosurg, 1999, 42(1): 27-31
24. Barajas Ma, Ramirez-Guzmun G, et al. Multimodal management of craniopharyngiomas: neuroendoscopy, microsurgery, and radiosurgery [J]. J Neurosury, 2002, 97(5 suppl): 607-609
25. Taniguchi M, et al. Application of a rigid endoscope to the micro-surgical management of 54 cerebral aneurysms: results in 48 patients [J]. J Neurosury, 1999, 91(2); 231-237
26. Alfieri A. Endoscopic endonasal transsphenoidal approach to the sellar region: technical evolution of the methodology and refinement of a dedicated instrumentation [J]. J Neurosurgy Sci, 1999, 43(2): 85-92
27. Jho HD, et al. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations [J]. Minim Invasive Neurosurg, 2001, 44: 1-12
28. Kato Y, et al. Endoscope-assisted microsurgery for cerebral aneurysms [J]. Minim Invasive Neurosurg, 2000, 43: 91-97
29. Gangemi M, et al .Endoscopic surgery for pineal region tumors [J]. Minim Invasive Neurosurg, 2001, 44: 70-73
30.刘丕楠,王忠诚,张亚卓,等.内镜下经鼻腔-蝶窦入路垂体腺瘤切除术[J].中华神经外科杂志, 2001, 17: 220-222
31.张亚卓,王忠诚,高鲜红,等.神经内镜手术并发症及防治[J].中华神经外科杂志, 2003, 19: 405-406
32. Fabnegas N, Lopez A, Valem R, et al .Anesthetic management of surgical neuroendoscopic usefulless of monitoring the pressure inside the meuroendoscope [J]. J Neurosurg, 2002, 12: 21-28
33. Oka K, Go Y, Yamamoto M, et al. Experience with an ultrasonic aspirator in neuroendoscopy [J]. Minim Invasive Neurosurg, 1999, 42(1): 32-34
34. Qiu Y, Lin Y, Pang Y, et al. Bipolar microscissors [J]. Minim Invasive Neurosurg, 2004, 47(5): 316-318
35. Willems PW, Vandertop WP, Verdaasdonk RM, et al. Contact laser-assisted neuroendoscopy can be performed safely by using pretreated 'black' fibre tips: experimental data [J]. Lasers Surg Med, 2001, 28(4): 324-329
36. Tirakotai W, Bozinov O, Sure U, et al. The evolution of stereotactic guidance in neuroendoscopy [J]. Childs Nerv Syst, 2004, 20(11-12): 790-795
37. Resch KD. Endo-neuro-sonography: first clinical series (52 cases) [J]. Childs Nerv Syst, 2003, 19(3): 137-144
38. Chen JC, Levy ML, Corber Z, et al. Concurrent three dimensional neuroendoscopy: initial descriptions of application to clinical practice [J]. Neurosurg Focus, 1999, 15:64-72
39. Aryan HE, Hoeg HD, Marshall LF, et al. Multidirectional projectional rigid neuro-endoscopy: prototype and initial experience [J]. Minim Invasive Neurosurg, 2005, 48(5): 293-296
40. Nguyen A, Aryan H, Jandial R, et al. Robotic virtual endoscopy: development of a multidirectional rigid endoscope [J]. Neurosurgery, 2006, 59: 134-141
41.詹升全,李昭杰,林志俊,等.神经内镜在脑外科的临床应用[J].中华外科杂志, 2002, 40: 187-190
42.王忠诚,张亚卓.微侵袭内镜神经外科的现状和展望[J].中华神经外科杂志, 2001, 17: 199-200