Intra-, Epidural And Intracranial Pressure Changes During Interlaminar Endoscopy, With and Without Dural Tear.

IF 3.6 2区 医学 Q1 CLINICAL NEUROLOGY
Neurospine Pub Date : 2025-06-01 Epub Date: 2025-06-30 DOI:10.14245/ns.2550456.228
Mazda Farshad, Jana Felicitas Schader, Alexandra Stauffer, Carl Moritz Zipser, Najmeh Kheram, José Miguel Spirig, Marie-Rosa Fasser, Jonas Widmer, Vincent Hagel
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引用次数: 0

Abstract

Objective: Endoscopic spine surgery implies possibly severe complications of the central nervous system, from headache to seizures and autonomic dysreflexia. These adverse events might be due to increased intracranial pressure (ICP), presumably induced by increased spinal intra-/epidural pressure caused by fluid irrigation. This study was designed to perform interlaminar endoscopic lumbar discectomy (IELD) at different irrigation fluid settings while monitoring its effect on intra-/epidural and ICPs, with and without dural tears.

Methods: Spinal intradural pressures were measured by introducing catheters through a sacral approach to human cadavers' lumbar, thoracic, and cervical levels. Additionally, an epidural probe was placed at L3-4. ICP was measured by an intraventricular probe. IELD was performed at L3-4, and the effect of varying irrigation pressures by different endoscopic pump systems and gravity-based irrigation on intra-/epidural and ICP pressures was measured before and after durotomy at L3-4.

Results: Intradural pressure at L3-4 correlated linearly with increasing irrigation pressure, irrespective of the used pump system (median pressure increase at 100-mmHg irrigation pressure: system I: 7 mmHg, r=0.94, p=0.002; system II: 7 mmHg, r=0.89, p=0.017) or gravity (8 mmHg, r=0.93, p=0.242). This effect was also seen intradurally at the thoracic/cervical spine, epidural, and intracranial level, and was even more pronounced with the maneuver of outflow-occlusion and a dural tear present.

Conclusion: While performing IELD, pump pressures correlated linearly to intra-/epidural pressures and ICPs. Pressures did not rise to concerningly high levels without outflow-occlusion, even with increased pump pressures. In the presence of a dural tear, higher pump pressures exacerbated by occlusion may lead to deleterious intradural and ICP elevations.

Abstract Image

Abstract Image

Abstract Image

有无硬膜撕裂时膜间内窥镜下硬膜内、硬膜外和颅内压的变化。
目的:内窥镜脊柱手术可能导致严重的中枢神经系统并发症,从头痛到癫痫发作和自主神经反射障碍。这些不良事件可能是由于颅内压(ICP)升高,可能是由液体冲洗引起的脊髓硬膜内/硬膜外压力升高引起的。本研究的目的是在不同的冲洗液设置下进行椎板间内窥镜腰椎间盘切除术(field),同时监测其对硬膜内/硬膜外和ICPs的影响,有无硬膜撕裂。方法:通过引入导管通过骶骨入路到人尸体的腰椎、胸椎和颈椎水平测量脊髓硬膜内压力。此外,在L3-4处放置硬膜外探头。颅内压测量采用脑室内探头。在L3-4进行field,并测量不同内镜泵系统和重力灌溉的不同冲洗压力对L3-4剖开硬膜前后硬膜内/硬膜外和ICP压力的影响。结果:L3-4硬膜内压力与灌水压力的增加呈线性相关,与使用的泵系统无关(100 mmHg灌水压力时中位压力增加:系统I: 7 mmHg, r=0.94, p=0.002;系统II: 7 mmHg, r=0.89, p=0.017)或重力(8 mmHg, r=0.93, p=0.242)。这种效果在胸椎/颈椎、硬膜外和颅内水平也可见,并且在流出封堵和硬膜撕裂的情况下更为明显。结论:在进行IELD时,泵压力与硬膜内/硬膜外压力和ICPs呈线性相关。在没有流出堵塞的情况下,即使泵压力增加,压力也不会上升到令人担忧的高水平。在存在硬脑膜撕裂的情况下,由于闭塞而加剧的高泵压可能导致有害的硬脑膜内和ICP升高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
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