Endoscopic surgery for intraventricular cystic lesions

Endoscopic surgery for intracranial cystic lesions with clear septum cysts, third ventricle gelatinous cysts and intraventricular cysticercosis. The transparent septum is a glial membrane structure between the lateral ventricles of both sides. In the embryonic period, there is a cavity called a transparent compartment, and then gradually merges. If the developmental malformation is incomplete, or the trauma, inflammation and other factors form a transparent septum cyst, the cyst will continue to enlarge the optic cavity, which may cause an increase in intracranial pressure; the third ventricle gel-like cyst and intraventricular cysticercosis often block the cerebrospinal fluid channel. In the past, craniotomy was used for such diseases, but the operation was traumatic, the postoperative reaction was heavy, and the complications were more. In recent years, endoscopic surgery at home and abroad has achieved good results. Treatment of diseases: transparent septum Indication 1. Significant headache, nausea, vomiting and papilledema and other intracranial hypertension. 2. CT, MRI examination showed a clear widening of the transparent septum, or cystic lesions in the lateral ventricle and third ventricle, with enlarged ventricles. Contraindications CT or MRI examination showed a slight increase in the transparent septum, or small cysts in the brain, but no obvious clinical symptoms. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. In recent years, due to advances in imaging inspection technology, clinical applications such as CT, MRI, and DSA have become increasingly widespread. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Skin preparation, wash the head with soap and water 1 day before the operation, shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 3. Fasting the morning of surgery. It can be enema in the evening before surgery, but when the intracranial pressure is increased, the enema should be removed to avoid sudden deterioration of the condition. 4. Give phenobarbital 0.1g orally before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. Surgical procedure 1. scalp incision and skull drilling Through the lateral ventricle approach of the frontal lobe, the intersection of 1 cm in front of the coronal suture and 3 cm in the midline was used, and a longitudinal incision of 2.5 to 3 cm was made. The diameter of the skull was 1 cm. When the longitudinal fissure approach is taken, 1 cm in front of the right coronal suture and 1 cm beside the midline, the skull is drilled, and the inner edge just exposes the right outer edge of the superior sagittal sinus. 2. Cut the brain dura The "ten" character cuts the dura mater and the endoscope is placed through the lateral ventricle. 3. Treatment of different cystic lesions 1 transparent septum cyst surgery: the use of a 4 ~ 6mm diameter hard endoscope into the right ventricle, after the cyst is found by bipolar coagulation to open the wall of the capsule, so that it communicates with the bilateral ventricles, and then expand the perforation with a balloon 5 to 10mm opening window. 2 third ventricle gel-like cyst surgery: endoscope through the interventricular space into the third ventricle to find the cyst, open the wall with a laser or micro-shear, absorb the viscous cyst fluid, and then remove the cyst wall. 3 intraventricular cysticercosis surgery: small or swimming cysticercosis can be sucked out through the endoscopic working channel; large cysticercosis or fixed cysticercosis difficulty in sucking, once ruptured, the cystic fluid is aspirated, and the head section and capsule are removed with a biopsy forceps Membrane, be careful not to miss multiple cysticercosis. 4. Guan skull After the lesion is treated, rinse with an appropriate amount of saline. After confirming that there is no bleeding, slowly withdraw from the endoscope, apply a gelatin sponge on the surface of the bone hole, and tightly suture the subcutaneous tissue and scalp. complication 1. The earliest and most serious complication after surgery is intracranial hemorrhage. A common cause is that hemostasis is not complete during surgery. Patients with concurrent intracranial hemorrhage, or delayed waking after surgery, or apathy, lethargy, headache, vomiting, seizures or re-coma after waking. Therefore, there is no special reason after surgery for a long time, not awake or consciousness is gradually worsened, and signs of increased intracranial pressure such as slow pulse, elevated blood pressure, or new neurological symptoms should be paid attention to, should be highly alert to the skull The possibility of internal bleeding. CT examination should be performed in time when conditions are met, and the hematoma should be removed immediately after diagnosis. The earlier the surgery, the better the consequences. 2. Silent, contralateral limb weakness, mostly temporary.

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