GLUBRAN®2 外科应用 GLUBRAN®2 GEM GEM S.r.l.

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1 GLUBRAN®2 外科应用 GLUBRAN®2 GEM GEM S.r.l.
Via dei Campi, 2 – PO Box 427 – Viareggio (LU) Italy Tel / Fax Web: GEM

2 GLUBRAN®2 GEM 神经外科手术

3 GLUBRAN®2 神经外科手术 GEM 中枢神经系统脑膜 皮肤 颅骨 硬脑膜 蛛网膜 软脑膜
Meningitis of the CNS Skin Periosteum Skull bone Dura Mater Arachnoid Pia mater 软脑膜 皮肤 骨膜 颅骨 硬脑膜蛛网膜 CNS meningitis : skin – periosteum – skull bone – dura mater – arachnoid – pia mater 皮下

4 Glubran 2用作硬头颅或脊柱的密封剂，防止中枢神经系统瘘和（或）加强缝线
GEM GLUBRAN®2 神经外科手术 Glubran 2用作硬头颅或脊柱的密封剂，防止中枢神经系统瘘和（或）加强缝线

5 GEM GLUBRAN®2 神经外科手术 应用Glubran 2 密封硬脑膜 Dr Jamous (Jordan)

6 在X射线透视下经蝶骨手术中应用GLUBRAN 2
GEM GLUBRAN®2 NEUROSURGERY 在X射线透视下经蝶骨手术中应用GLUBRAN 2 Dr. Alberto Torres Servicio de Neurocirugía Hospital Universitario de Bellvitge Universidad de Barcelona

7 垂体 GEM 垂体退化为分泌激素，调节机体功能。 PITUITARY GLAND
脑垂体 胼胝体 丘脑 The success of the surgery depends on the type of tumor, location, size, and on whether the surrounding tissues are invaded. In most patients the surgical therapy allows a positive prognosis and complete healing. 视交叉 垂体前叶 垂体后叶 PITUITARY GLAND Corpus callosum - Thalamus – Pineal – Hypothalamus – Brain stem – Pituitary (hypophysis) Optic chiasma - Anterior lobe-gland tissue – Posterior lobe-nerve tissue 胼胝体 丘脑 松果体 下丘脑 脑干 垂体 视交叉 前叶-腺组织 后叶-神经组织

8 垂体腺瘤 GEM 垂体腺瘤脑垂体的一种良性瘤。 当垂体腺瘤压迫周围组织结构或垂体分泌过多时，必须手术切除。 手术入路的选择: 经蝶骨
The success of the surgery depends on the type of tumor, location, size, and on whether the surrounding tissues are invaded. In most patients the surgical therapy allows a positive prognosis and complete healing.

9 经蝶骨手术 GEM 在X射线透视下，经鼻腔然后穿透蝶骨和蝶鞍，到达脑垂体 脑垂体（腺瘤） –蝶鞍–蝶窦
Sfondamento sella turcica 穿透蝶鞍 蝶鞍 蝶窦 Sfondamento osso sfenoide 穿透蝶骨 脑垂体（腺瘤） –蝶鞍–蝶窦 经海绵窦达前部:穿透蝶鞍-穿透蝶骨（脑垂体-蝶窦-鼻咽）

10 GEM 优点 该手术 : 侵入性最小 无外部切口 并发症最小，住院时间最短

11 可能的并发症 GEM X射线透视下经蝶骨手术最常见的并发症是鼻瘘: 脑蛛网膜下腔与鼻腔非正常连通
瘘的临床表现为液溢 ，也就是澄清液体持续从鼻部流出。

12 在手术进入点用 Glubran 2封闭蛛网膜下腔!
GEM 如何防止脑脊液瘘? 在手术进入点用 Glubran 2封闭蛛网膜下腔!

13 经蝶骨手术 GEM 在手术末尾，用各种自体移植物和（或）人造组织（胶原），以重建技术修补到达脑垂体的骨开口，并用外科胶密封。
By means of endoscopy the access is through a natural way which is the sphenoid sinus From here, we reach the sella turcica where is the pituitary gland. The tumor is removed and at the end of the procedure, the “pituitary room” is repaired by means of reconstruction techniques with grafts of muscle and / or fat taken from the same patient, bits of cartilage of the nasal septum and / or of artificial tissue and sealed with surgical glue . Generally, the incidence of fistula is of % of cases 在手术末尾，用各种自体移植物和（或）人造组织（胶原），以重建技术修补到达脑垂体的骨开口，并用外科胶密封。

14 GEM GLUBRAN 2应用 完成重建后，加强硬脑脊膜的密封， …防止脑脊液瘘形成! 用长的黄色喷雾液

15 GEM 经蝶骨手术后的骨重建操作 脑 蛛网膜下腔 硬膜下腔 颅骨 鼻
胶原筋膜 By means of endoscopy the access is through a natural way which is the sphenoid sinus From here, we reach the sella turcica where is the pituitary gland. The tumor is removed and at the end of the procedure, the “pituitary room” is repaired by means of reconstruction techniques with grafts of muscle and / or fat taken from the same patient, bits of cartilage of the nasal septum and / or of artificial tissue and sealed with surgical glue . Generally, the incidence of fistula is of % of cases 颅骨 带蒂皮瓣 鼻

16 Dr. Alberto Torres - Barcelona
GEM GLUBRAN®2 神经外科手术 Dr. Alberto Torres - Barcelona

17 Dr. Alberto Torres - Barcelona
GEM GLUBRAN®2 神经外科手术 Dr. Alberto Torres - Barcelona

18 GEM 文献报道，病例中瘘发生率为0.5-21% 经蝶骨透视应用Glubran 2的学习曲线 Dr. Torres 瘘发生率

19 GEM GLUBRAN®2 神经外科手术 参考书目 Glubran2丙烯酸胶对猪蛛网膜下表面的效果 初步结果

20 GLUBRAN®2 神经外科手术 GEM 目的：将Glubran 2直接接触脑组织，以考察其体内的即时相容性和可耐受性以及可能的组织损伤。
本研究对评价动脉瘤、机械辅助心室和瘘栓塞手术的并发症非常有用。 操作: 3只猪行外科手术，在不同时间处死。取脑部进行目视检查、组织学检查和镜检。 结论: 总之, Glubran 2的体内可耐受性良好，不对直接接触的脑组织产生严重损伤。 Abstract: Evaluation of Glubran 2 for the treatment of complications during embolization of aneurysms, MAV or fistulas. A possible complication is the rupture of the vessel wall with the micro-guide or the drilling of the aneurysmal sac with the coil used for embolization. The complication may be resolved by injecting Glubran 2 in the breaking point. This would directly put the product in contact with the subarachnoid space and with the adjacent brain tissue. Scope: Put Glubran 2 in direct contact with the brain tissue to ascertain its immediate compatibility and tolerability in vivo, and the possible tissue damage. Procedure: Three pigs were subjected to neurosurgical procedures and sacrificed at various times. The brain was explanted and histological macroscopic and microscopic investigations were carried out . Conclusions: Overall, Glubran 2 was well tolerated in vivo and did not cause serious damage in direct contact with the brain tissue.

21 GEM GLUBRAN®2 神经外科手术 用冻干的硬物片填充硬脑脊膜缺损，用Glubran 2固定在切除椎骨的后弓边缘 The lack of dural tissue was filled with patches of lyophilised dura mater fixed to the edges of the laminectomy by Glubran 2

22 GEM 硬脑脊膜密封剂的竞争者 TISSUCOL DuraSeal Baxter Covidien 人冻干凝血酶 聚乙二醇 +三赖氨酸
(源自欧洲输血中心) 纤维蛋白原 DuraSeal Covidien 聚乙二醇 +三赖氨酸