使用吲哚菁绿进行三叉神经微血管减压的内镜辅助外镜手术

Surgeries Pub Date : 2024-04-01 DOI:10.3390/surgeries5020017
R. Sufianov, N. A. Garifullina, Asiyat Sh. Magomedova, Michael G. Hevor, M.J. Encarnacion Ramirez, Albert A. Sufianov, N. Montemurro
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摘要

三叉神经痛(TN)是一种慢性疾病,通常是由于血管在根部入口区对 V 颅神经施压所致。治疗 TN 的金标准是微血管减压术 (MVD)。本病例展示了一种先进的手术技术,该技术结合使用外窥镜和内窥镜来治疗 TN,并创新性地增加了术中吲哚菁绿(ICG)控制,可改善动脉和静脉压迫的识别。外窥镜和内窥镜的使用提供了 360° 根部评估,代表了手术方法的重大发展。使用 ICG 增强可视化有助于识别复杂的神经血管冲突,提高减压的准确性。同时使用外窥镜和内窥镜进行 360° 根部评估,是 TN 显微手术方法的重大变革。在动态模式下额外使用 ICG 监测可能有助于识别复杂的动静脉形式的神经血管冲突。内镜辅助外镜手术在术中使用 ICG 治疗三叉神经血管内膜脱垂,可提高对复杂撞击的识别能力,凸显了其在神经外科实践中的有效性和潜力。
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Endoscopically Assisted Exoscopic Surgery for Microvascular Decompression of the Trigeminal Nerve with Intraoperative Use of Indocyanine Green
Trigeminal neuralgia (TN) is a chronic condition that is typically caused by a blood vessel exerting pressure on the V cranial nerve at the root entry zone. The gold standard for TN treatment is microvascular decompression (MVD). This illustrative case shows an advanced surgical technique that combines the use of an exoscope and endoscope to treat TN with an innovative addition of intraoperative indocyanine green (ICG) control that can improve arterial and venous compression identification. The use of exoscopes and endoscopes, offering 360° root assessment, represents a significant evolution in surgical approaches. Enhanced visualization with ICG aided in identifying complex neurovascular conflicts, improving decompression accuracy. The use of both exoscope and endoscope, offering a 360° root assessment, represents a significant evolution in the microsurgical approach of TN. The additional use of ICG monitoring in a dynamic mode may be useful in identifying the complex arteriovenous form of neurovascular conflict. The endoscopically assisted exoscopic surgery with the intraoperative use of ICG for MVD of the trigeminal nerve can improve the identification of complex impingements underlining its effectiveness and potential in neurosurgical practice.
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