颈椎全内镜脊柱手术对猪颅内压的影响
Impact of cervical full-endoscopic spine surgery on intracranial pressure in swine.
文献信息
| PMID | 42761525 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Marcelo Campos Moraes Amato |
| 作者单位 | Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. |
| 期刊 | Brain & spine |
| SCI 分区 | Q3 |
| IF | 2.8 |
| 研究类型 | 基础研究 · 基础／转化 |
| 所属专科 | 耳科 |
中文摘要
引言： 颈椎全内镜脊柱手术（FESS）的临床应用日益增多，但灌洗对颅内压（ICP）的影响仍知之甚少，并可能带来神经系统风险。
研究问题： 在不同灌洗参数、引流闭塞状态和麻醉深度下，颈椎FESS是否较既往腰椎数据引起相关的ICP升高。
材料与方法： 在对照猪模型中，四头雌性家猪（Sus scrofa domesticus，50-75 kg）在全静脉麻醉下接受颈椎FESS，使用单孔双通道吸引-灌洗内镜。通过脑实质内导管有创监测ICP。灌洗泵设置以分级配置进行测试，引流出口开放、部分闭塞或完全闭塞。调节麻醉深度以评估其对ICP动态的影响。
结果： 基线ICP平均为11.1 mmHg。颈椎FESS引起明显的ICP升高，尤其在引流部分和完全梗阻期间，峰值高达102 mmHg。在开放引流下，ICP范围为7.9至29.1 mmHg，偶尔超过20 mmHg的安全阈值，但仍低于闭塞期间。在麻醉深度调节下，轻度镇静产生高达62.5 mmHg的闭塞峰值，而较深麻醉与开放引流ICP 9.5-19.7 mmHg及闭塞峰值23-36.6 mmHg相关。
讨论与结论： 与腰椎手术相比，颈椎FESS与更早且更明显的ICP升高相关。盐水流出道闭塞是临界压力骤升的主要触发因素，而泵参数调节其幅度。较深麻醉与减弱的ICP反应相关。保持引流通畅、使用最低有效泵设置以及适当的麻醉管理可能降低临界颅内高压的风险。
英文摘要
INTRODUCTION: Cervical full-endoscopic spine surgery (FESS) has grown in clinical use, but the effects of irrigation on intracranial pressure (ICP) remain poorly understood and may pose neurological risks.
RESEARCH QUESTION: Whether cervical FESS induces relevant ICP increases compared with prior lumbar data, under different irrigation parameters, drainage occlusion states, and anesthesia depths.
MATERIAL AND METHODS: In a controlled swine model, four female Sus scrofa domesticus (50-75 kg) underwent cervical FESS with a uniportal, dual-channel suction-irrigation endoscope under total intravenous anesthesia. ICP was monitored invasively via intraparenchymal catheter. Irrigation pump settings were tested in graded configurations with drainage outflow open, partially occluded, or totally occluded. Anesthesia depth was modulated to assess its influence on ICP dynamics.
RESULTS: Baseline ICP averaged 11.1 mmHg. Cervical FESS produced marked ICP increases, particularly during partial and total drainage obstruction, with peaks up to 102 mmHg. Under open drainage, ICP ranged from 7.9 to 29.1 mmHg, occasionally exceeding the 20 mmHg safety threshold but remaining lower than during occlusion. With anesthesia-depth modulation, mild sedation yielded occlusion peaks up to 62.5 mmHg, whereas deeper anesthesia was associated with open-drainage ICP of 9.5-19.7 mmHg and occlusion peaks of 23-36.6 mmHg.
DISCUSSION AND CONCLUSION: Cervical FESS was associated with earlier and more pronounced ICP elevations than lumbar procedures. Saline outflow occlusion is the primary trigger of critical pressure surges, while pump parameters modulate magnitude. Deeper anesthesia was associated with attenuated ICP responses. Maintaining drainage patency, using the lowest effective pump settings, and appropriate anesthetic management may reduce the risk of critical intracranial hypertension.