内視鏡下脳室内手術の環境構築と周術期管理

Optimization of the Surgical Environment and Perioperative Management in Endoscopic Intraventricular Surgery

Point

・オリエンテーションを失わない手術環境の構築を行う．

・エコーやナビゲーションを積極的に用いる．

・脆弱な脳室内環境を前提とした丁寧で落ち着いた操作を心掛ける．

・助手は「水かけ」と「声かけ」による手術室全体の最適化を行う．

　Neuroendoscopic intraventricular surgery provides a minimally invasive approach but is inherently challenging, as it is performed within a fragile, three-dimensional ventricular space while relying on a limited two-dimensional endoscopic view. Loss of orientation and subtle technical errors can result in hemorrhage or neural injury. This chapter describes practical strategies for achieving stable and reproducible neuroendoscopic intraventricular surgery, with emphasis on operating room setup, instrumentation, teamwork, and perioperative management.

　Key principles include aligning the surgeon, patient, and monitor to maintain visuomotor consistency; proactive use of navigation and intraoperative ultrasound to prevent misplacement; and gentle, deliberate manipulation of the vulnerability of ventricular structures. Instrument selection, including rigid scopes, channel-based rigid endoscopic systems, and coagulation-suction devices, is discussed from a safety-oriented perspective.

　A central emphasis is placed on the role of the assistant, whose responsibilities extend beyond irrigation control ( “water management” ) to include verbal cues and optimization of the surgical environment. Perioperative management, particularly external ventricular drainage (EVD) strategies, postoperative fever, and the role of neuroendoscopic ventricular irrigation in ventriculitis, are also reviewed. Collectively, these concepts highlight that successful neuroendoscopic surgery depends not only on technical proficiency but also on comprehensive surgical design and effective team coordination.