JP2016016207A - Resection method of intracranial tissue and treatment method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a method for inhibiting an increase in brain pressure when resecting the intracranial tissue by liquid injection.SOLUTION: An injection tube is inserted into the cranium. Subsequently, a liquid that has biocompatibility and to which a pulse flow is applied is injected from the injection tube to resect the intracranial tissue. According to the present embodiment, an amount of liquid flowing in the brain is reduced so as to inhibit the increase in the brain pressure. A flow rate of the liquid to be injected per unit time may be controlled on the basis of the intracranial pressure. Further, fluctuation in the intracranial pressure may be mitigated.SELECTED DRAWING: Figure 7

Description

  The present invention relates to resection of intracranial tissue.

  2. Description of the Related Art A medical device in which an endoscope is combined with a liquid ejecting apparatus (water jet knife) is known. This medical device excises an affected part by ejecting water as a continuous flow from an injection tube inserted into an insertion part of the endoscope under a field of view by an endoscope (for example, Patent Document 1).

JP 2004-105367 A

  In the case of the above prior art, when the intracranial tissue is excised by liquid ejection, the brain pressure may increase. When liquid is ejected in the cranium, brain pressure may increase due to the influence of the liquid. An object of the present invention is to suppress such an increase in brain pressure.

  SUMMARY An advantage of some aspects of the invention is to solve the above-described problems, and the invention can be implemented as the following forms.

(1) According to one form of this invention, the excision method of the intracranial tissue is provided. The method includes the step of inserting an ejection tube into the cranium; and a biocompatible liquid, pulsating fluid is ejected from the ejection tube to ablate tissue in the skull. Steps. According to this aspect, since the pulsating flow is imparted to the liquid to be ejected, the pressure fluctuation due to the pulsating flow and the effect of repeatedly ejecting the liquid that is instantaneously pressurized compared to the method of ejecting the liquid continuously Thus, the flow rate for securing the necessary excision ability is small. Therefore, according to this embodiment, the amount of liquid flowing into the brain is reduced, and as a result, the increase in brain pressure is suppressed.

(2) In the above aspect, in the excision step, the flow rate of the liquid ejected per unit time may be controlled based on the pressure in the skull. According to this aspect, it is possible to suppress an increase in the pressure in the cranium by controlling the flow rate of the liquid ejected per unit time based on the pressure in the cranium.

(3) In the above aspect, in the excision step, fluctuations in pressure in the skull may be alleviated. According to this form, the pressure fluctuation in the skull is relieved.

(4) In the above embodiment, the relaxation may be realized by an accumulator inserted into the skull. According to this form, the pressure fluctuation caused by the pulsating flow is alleviated.

(5) In the above embodiment, the relaxation may be realized by a tube for discharging the liquid in the cranium to the outside. According to this embodiment, the brain pressure is suppressed from reaching a predetermined value or more.

(6) In the above configuration, the method includes a step of inserting a conduit into the skull; and a step of passing an endoscope through the conduit after the insertion of the conduit; and the step of inserting the ejection tube includes the step of inserting the injection tube It may be a step of inserting the injection tube into the conduit after the step of passing. According to this embodiment, since the inside of the skull can be confirmed with an endoscope, it is not necessary to make a large hole in the skull. Since the liquid in which the pulsating flow is given is ejected and the tissue in the cranium is excised, the amount of the liquid flowing into the brain is reduced, and the increase in the brain pressure is suppressed.

(7) In the above embodiment, the method includes a conduit insertion step of inserting the first and second conduits into the skull; and a step of passing an endoscope through the first conduit after the insertion of the first conduit; The step of inserting the injection tube may be a step of inserting the injection tube into the second conduit after the insertion of the second conduit. According to this aspect, since the state of the injection tube inserted into the second conduit can be confirmed by the endoscope of the first conduit, the excision is facilitated, and as a result, the treatment time is shortened. The amount of liquid flowing into the brain is reduced, and as a result, the increase in brain pressure is suppressed. In addition, by pulling out the endoscope from the first conduit, the first conduit can be used as a tube for discharging the liquid in the skull to the outside, and the brain pressure reaches a predetermined value or more. Is suppressed. Since the same effect can be obtained even if the ejection tube is pulled out from the second conduit, either the endoscope or the ejection tube may be pulled out.

  The present invention can be realized in various forms other than the above. For example, it can be realized in the form of a treatment method using the above excision method.

The block diagram of a liquid ejecting apparatus. Sectional drawing of the internal structure of a pulsating flow generation unit. The figure which shows the waveform of the drive voltage applied to a piezoelectric element. The figure which shows the correspondence of the waveform of a drive voltage, and the mode of a deformation | transformation of a diaphragm. The perspective view of an endoscope. The enlarged view of the front-end | tip part of an endoscope. The flowchart which shows the procedure of a treatment method. The schematic diagram for demonstrating insertion of a trocar. The schematic diagram for demonstrating insertion of an endoscope. The schematic diagram for demonstrating insertion of a connection flow path and an injection pipe. The schematic diagram for demonstrating resection of a tumor. FIG. 6 is a schematic diagram showing a state where a pressure sensor is inserted into a skull (second embodiment). FIG. 6 is a configuration diagram of a liquid ejecting apparatus (third embodiment). FIG. 6 is a schematic diagram showing a state where an accumulator is placed in a ventricle (Embodiment 4). FIG. 10 is a schematic diagram showing a state where a pressure release tube is inserted into the brain (Embodiment 5). FIG. 10 is a configuration diagram of a liquid ejecting apparatus (sixth embodiment). The flowchart which shows the procedure of a treatment method (Embodiment 6). The schematic diagram which shows a mode that the 2nd trocar was inserted in the skull (Embodiment 6). The schematic diagram which shows a mode that the injection pipe was inserted in the 2nd trocar (Embodiment 6).

  Embodiment 1 will be described. FIG. 1 shows a configuration of the liquid ejecting apparatus 10. The liquid ejecting apparatus 10 is a medical device used in a medical institution, and has a function of excising an affected part by ejecting liquid into the affected part in pulses. The liquid ejecting apparatus 10 is used in combination with an endoscope 100 (FIG. 5) described later.

  The liquid ejecting apparatus 10 includes a pulsating flow generation unit 30, a liquid supply mechanism 50, a flow path 51, a flow path 52, a connection flow path 53, a liquid container 59, a control device 70, a signal line 71, A signal line 72 and a foot switch 75 are provided.

  The liquid supply mechanism 50 sucks the liquid stored in the liquid container 59 through the flow path 51 and supplies it to the pulsating flow generation unit 30 through the flow path 52. This liquid is physiological saline. The pulsating flow generation unit 30 generates a pulsating flow in the supplied liquid. The liquid in which the pulsating flow is ejected is ejected from the ejection pipe 55 provided with a nozzle at the tip via the connection channel 53.

  The connection flow path 53 is formed of PEEK (registered trademark) resin. The PEEK resin is an insulator and has high flexibility while having flexibility. The injection pipe 55 is a metal pipe provided at the tip of the connection flow path 53.

  Since the pulsating flow is generated in the liquid supplied to the ejection pipe 55, the liquid is ejected in a pulse shape as described above. In addition, the pulse-like injection in the present application means that the injection is performed in a state where the flow rate or the flow velocity is fluctuated, and is not limited to repeating the injection and the stop of the liquid. That is, it includes various injection forms such as a form in which the injection is completely interrupted between injections and a form in which a low-pressure flow exists between the injections.

  As shown in FIG. 1, the control device 70 controls the operations of the pulsating flow generation unit 30 and the liquid supply mechanism 50. The control device 70 always transmits a signal for supplying the liquid to the liquid supply mechanism 50 via the signal line 71 during activation. The control device 70 transmits a signal for generating a pulsating flow to the pulsating flow generating unit 30 via the signal line 72 while the foot switch 75 is being depressed.

  FIG. 2 is a cross-sectional view of the internal configuration of the pulsating flow generation unit 30. The pulsating flow generation unit 30 includes a pulsating flow generation unit 31 and a liquid chamber 42. The pulsating flow generation unit 31 includes a diaphragm 32 and a piezoelectric element 33 as a volume changing unit.

  The liquid chamber 42 is a space between the first case 34 and the diaphragm 32, and forms a flow path between the flow path 52 and the connection flow path 53. The diaphragm 32 is a disk-shaped thin metal plate, and an outer peripheral portion thereof is sandwiched and fixed between the first case 34 and the second case 36.

  The piezoelectric element 33 is an actuator that operates according to a drive voltage applied from the control device 70. The piezoelectric element 33 varies the pressure of the liquid in the liquid chamber 42 by varying the volume of the liquid chamber 42 formed between the diaphragm 32 and the first case 34. The piezoelectric element 33 is a multilayer piezoelectric element, and one end is fixed to the diaphragm 32 and the other end is fixed to the third case 38.

  When the drive voltage applied to the piezoelectric element 33 increases, the piezoelectric element 33 expands, and the diaphragm 32 is pushed by the piezoelectric element 33 and bent toward the liquid chamber 42 side. When the diaphragm 32 bends toward the liquid chamber 42, the volume of the liquid chamber 42 decreases, and the liquid in the liquid chamber 42 is pushed out from the liquid chamber 42 to the connection channel 53.

  On the other hand, when the drive voltage applied to the piezoelectric element 33 is reduced, the piezoelectric element 33 is reduced, the volume of the liquid chamber 42 is increased, and the liquid flows into the liquid chamber 42 from the flow path 52.

  The drive voltage applied to the piezoelectric element 33 from the control device 70 is repeatedly turned on (maximum voltage) and turned off (0 V) at a predetermined frequency (for example, 400 Hz), so that the expansion and reduction of the volume of the liquid chamber 42 are repeated. A pulsating flow is generated in the liquid.

  FIG. 3 shows an example of the waveform of the drive voltage applied to the piezoelectric element 33. In FIG. 3, the horizontal axis indicates time, and the vertical axis indicates drive voltage. One cycle of the waveform of the drive voltage includes a rising period (b) in which the voltage increases, a time (c) at which the voltage becomes maximum, a falling period (d) in which the voltage decreases, and a pause period in which no voltage is applied ( a) and (e).

  The waveform of the rising period of the drive voltage is a waveform corresponding to ½ period of the sin waveform offset in the positive voltage direction and shifted in phase by −90 degrees. The waveform of the falling period of the drive voltage is a waveform corresponding to ½ period of the sin waveform offset in the positive voltage direction and shifted in phase by +90 degrees. The period of the sin waveform in the falling period is larger than the period of the sin waveform in the rising period.

  When the magnitude of the drive voltage is changed, the maximum value of the waveform shown in FIG. 3 is changed. In addition, when the frequency of the drive voltage is changed, the waveforms of the rising period and the falling period are not changed, and the length of the pause period is changed.

  FIG. 4 shows a correspondence relationship between the waveform of the drive voltage and the state of deformation of the diaphragm 32. In FIG. 4, a reinforcing member 39 is provided between the piezoelectric element 33 and the diaphragm 32. In the rest period (a), since the drive voltage is not applied, the piezoelectric element 33 is not expanded and the diaphragm 32 is not bent. In the rising period (b), since the driving voltage increases, the piezoelectric element 33 expands, the diaphragm 32 bends toward the liquid chamber 42, and the volume of the liquid chamber 42 decreases.

  At time (c), since the drive voltage is maximized, the length of the piezoelectric element 33 is also maximized, and the volume of the liquid chamber 42 is minimized. In the falling period (d), since the drive voltage becomes small, the piezoelectric element 33 starts to return to the original size, and the volume of the liquid chamber 42 starts to return to the original size. In the rest period (e), since the drive voltage is not applied, the piezoelectric element 33 returns to the original size, and the volume of the liquid chamber 42 returns to the original size. By repeating a series of operations shown in (a) to (e), a pulsating flow is generated in the liquid in the liquid chamber 42.

  FIG. 5 is a perspective view of the endoscope 100. The endoscope 100 is a known flexible endoscope. FIG. 5 shows a state where the liquid ejecting apparatus 10 is combined as described above.

  The endoscope 100 includes an insertion part 110, a connection channel insertion port 130, a grip part 140, an operation part 150, and a connection part 160. The insertion part 110 includes a flexible part 113, a bending part 115, and a tip part 120.

  FIG. 6 is an enlarged view of the distal end portion 120. The tip 120 is provided with a light 121, an objective lens 122, an air / water inlet 123, an intake water inlet 124, and an opening 125. The objective lens 122 is connected to an optical fiber (not shown) and is provided for observing the vicinity of the distal end portion 120. The light 121 emits light for this observation.

  The air / water supply port 123 is an opening for discharging a liquid such as air or physiological saline. The intake water inlet 124 is an opening for sucking in ambient air and liquid. The opening 125 is provided to expose the injection tube 55, and the inserted injection tube 55 is shown in FIG.

  The soft part 113 shown in FIG. 5 is formed of a material that bends flexibly, and the connection channel 53 is inserted therein. The bending direction of the bending portion 115 changes depending on the operation of the operation portion 150. The connection channel insertion port 130 is an opening for inserting the connection channel 53 and the injection pipe 55 into the insertion unit 110.

  The grasping part 140 is connected to the insertion part 110 and is a part for the operator to grasp. An operation unit 150 is provided above the grip unit 140. As described above, the operation unit 150 is provided with a knob for operating the direction of the bending portion 115 and buttons for operating the above-described air supply / water supply and intake water absorption. The connection unit 160 is connected to the above-described illumination by the light 121, a control device for realizing air supply / water supply, intake water absorption, a display for displaying an image photographed by the objective lens 122, and the like.

  FIG. 7 is a flowchart schematically showing a procedure of a treatment method by excision of intracranial tissue. In this treatment method, the liquid ejecting apparatus 10 and the endoscope 100 described above are used. In the present embodiment, the subject of treatment is a human.

  First, the operator covers the patient's head with drape and opens the skull (step S210). Subsequently, the surgeon inserts the trocar 300 from the opened site (step S220). FIG. 8 is a schematic diagram for explaining step S220. The surgeon inserts the trocar 300 into the brain B from the opened site and places the tip of the trocar 300 in the ventricle C. The trocar 300 is a known surgical instrument and is a tubular member.

  As shown in FIG. 8, in the vicinity of the ventricle C, there is a tumor T that is an affected part. A blood vessel V runs in the vicinity of the tumor T. This treatment method is characterized by excising the tumor T, which is an intracranial tissue, while preserving the blood vessel V.

  Subsequently, the surgeon inserts the insertion unit 110 of the endoscope 100 into the trocar 300 (step S230). FIG. 9 is a schematic diagram for explaining step S230. The surgeon inserts the insertion portion 110 of the endoscope 100 into the trocar 300 and places the distal end portion 120 near the tumor T. As shown in FIG. 9, the insertion part 110 includes a stopper 190 (not shown in FIG. 5). The stopper 190 is a portion having an outer diameter larger than that of the insertion portion 110, and is provided so that the insertion of the insertion portion 110 does not become too deep.

  Next, the surgeon inserts the connection channel 53 and the ejection tube 55 into the insertion part 110 of the endoscope 100 (step S240). By inserting the connection flow path 53 and the ejection pipe 55 into the endoscope 100 in this way, the connection flow path 53 and the ejection pipe 55 are inserted into the trocar 300 as a result. FIG. 10 is a schematic diagram for explaining step S240. The surgeon inserts the connection flow path 53 and the ejection tube 55 so that the ejection tube 55 is disposed in the vicinity of the tumor T.

  The surgeon may project all of the ejection tube 55 from the opening 125 of the distal end portion 120, or may accommodate the entire ejection tube 55 in the insertion portion 110, or as illustrated in FIG. A part of 55 may protrude from the opening 125 of the tip 120. The operator may bring the ejection tube 55 into contact with the tumor T, or may not bring the ejection tube 55 into contact with the tumor T as shown in FIG. Further, the connection channel 53 and the ejection tube 55 may be inserted into the trocar 300 side by side with the endoscope 100 without being inserted into the insertion portion 110 of the endoscope 100.

  Finally, the tumor T is excised by jetting the liquid to which the pulsating flow is applied (step S250). FIG. 11 is a schematic diagram for explaining step S250. The surgeon operates the foot switch 75 (FIG. 1) to generate a pulsating flow in the liquid ejected from the ejection tube 55. The operator adjusts the position of the ejection tube 55 by operating the connection channel 53 and the bending portion 115 of the endoscope 100. The operator can accurately eject the liquid to the tumor T by performing this position adjustment while observing the image taken by the endoscope 100.

  As described above, the liquid ejection by the liquid ejecting apparatus 10 is given a pulsating flow. Therefore, the resecting capability can be ensured with a small flow rate as compared with the ejection of liquid to which no pulsating flow is applied. As a result, the amount of liquid flowing into the ventricle C can be reduced, and as a result, an increase in brain pressure can be suppressed.

  In addition, according to the liquid jet to which the pulsating flow is applied, the tumor T can be excised while the blood vessel is not easily incised. Therefore, the surgeon can easily preserve the blood vessel V that runs in the vicinity of the tumor T.

  A second embodiment will be described. FIG. 12 is a schematic diagram showing a state in which the pressure sensor 400 is inserted into the skull. The surgeon inserts the pressure sensor 400 at any stage prior to step S250 described above. As shown in FIG. 12, the pressure sensor 400 includes a pressure detection unit 410. The surgeon inserts the pressure sensor 400 so that the pressure detection unit 410 is disposed in the ventricle C.

  The measurement value obtained by the pressure sensor 400 is output by an output device (not shown) such as a display or a speaker. By recognizing the output value, the surgeon can be careful not to raise the brain pressure too much.

  A third embodiment will be described. FIG. 13 shows a configuration of the liquid ejecting apparatus 10a. The liquid ejecting apparatus 10a differs from the liquid ejecting apparatus 10 of Embodiment 1 in that the pressure sensor 400 is connected to the control device 70a.

  The control device 70a controls the flow rate supplied by the liquid supply mechanism 50 per unit time based on the measurement value input from the pressure sensor 400. Various control methods are conceivable. For example, when the measured value is greater than or equal to the reference value, the liquid supply mechanism 50 may be stopped. By controlling in this way, it becomes easy to avoid that the brain pressure reaches a reference value or more. In addition, when the measured value rises and approaches the reference value, the supply flow rate by the liquid supply mechanism 50 may be gradually decreased, and when the measured value reaches the reference value, the liquid supply mechanism 50 may be stopped. By controlling in this way, the frequency of stopping the liquid supply mechanism 50 is reduced, so that surgery is facilitated.

  A fourth embodiment will be described. FIG. 14 is a schematic diagram showing a state where the accumulator 500 is disposed in the ventricle C. FIG. The surgeon places the accumulator 500 at any stage prior to step S250 described above.

  The accumulator 500 suppresses fluctuations in brain pressure by absorbing pressure fluctuations in the ventricle C. The accumulator 500 can be realized by, for example, a bag filled with gas. By arranging the accumulator 500 in the ventricle C, the fluctuation of the brain pressure accompanying the pulsating flow is suppressed.

  A fifth embodiment will be described. FIG. 15 is a schematic diagram illustrating a state where the pressure release tube 600 is inserted into the brain B. The surgeon inserts the pressure release tube 600 at any stage prior to step S250 described above.

  As shown in FIG. 15, one end of the pressure release tube 600 is disposed in the ventricle C, and the other end is disposed outside the skull. Therefore, when the brain pressure increases, the liquid flows out of the cranium from the ventricle C through the pressure release tube 600. The liquid that flows out is cerebrospinal fluid or physiological saline ejected from the ejection tube 55. According to the fifth embodiment, the brain pressure is prevented from increasing beyond a predetermined value.

  The pressure release pipe 600 may be used for other purposes. For example, the excised tissue may be used to suck out by negative pressure. When the excised tissue is sucked out, it may be sucked out together with the liquid in the ventricle C. When the liquid is sucked out in this way, new physiological saline may be flowed into the ventricle C.

  A sixth embodiment will be described. FIG. 16 shows a configuration of the liquid ejecting apparatus 10b. The liquid ejecting apparatus 10 b has a configuration in which a hand piece 80 is connected to the tip of the connection flow path 53. An injection pipe 55 b is connected to the tip of the handpiece 80. The handpiece 80 is a part for the operator to grasp. The connection flow path 53 and the injection pipe 55b are connected in the handpiece 80.

  FIG. 17 is a flowchart schematically showing the procedure of the treatment method of the present embodiment. Steps S210 to S230 are the same as those in the first embodiment, and a description thereof will be omitted. After step S230, the second trocar 310 is inserted into the skull (step S235), and then the ejection tube 55b is inserted into the second trocar 310 (step S241).

  FIG. 18 is a schematic diagram showing a state where the second trocar 310 is inserted into the skull. The surgeon inserts the second trocar 310 so that the end of the second trocar 310 is located in the ventricle C. The surgeon can grasp the position of the tip of the second trocar 310 by observing an image captured by the endoscope 100.

  FIG. 19 is a schematic diagram showing a state where the injection pipe 55b is inserted into the second trocar 310. FIG. Thereafter, the surgeon removes the tumor T by jetting the liquid (step S250).

  According to the sixth embodiment, the operator grasps the handpiece 80 for the adjustment of the distal end position of the ejection tube 55b, and this adjustment becomes easy.

  The present invention is not limited to the embodiments, examples, and modifications of the present specification, and can be implemented with various configurations without departing from the spirit of the present invention. For example, the technical features in the embodiments, examples, and modifications corresponding to the technical features in the embodiments described in the summary section of the invention are to solve some or all of the above-described problems, or In order to achieve part or all of the effects described above, replacement or combination can be performed as appropriate. If the technical feature is not described as essential in this specification, it can be deleted as appropriate. For example, the following are exemplified.

  The liquid ejecting apparatus may be configured to select either a mode for ejecting at a large flow rate in a short time or a mode for ejecting at a small flow rate for a long time. In this case, the operator may select the mode according to the case.

  The endoscope may be either a soft type or a hard type. Further, the liquid ejecting apparatus may be either the one of the first embodiment or the sixth embodiment. The endoscope and the liquid ejecting apparatus may be used in appropriate combination.

  You may insert an injection pipe and a connection flow path from other than the site | part which opened. For example, it may be inserted via the nose.

  The pulsating flow generation unit may have a mechanism different from that of the embodiment as long as it has a function of generating a large pressure fluctuation within a short time. For example, the pulsating flow may be generated by generating bubbles in the liquid in the liquid chamber. Specifically, heating means such as a resistor heater, a ceramic heater, a microwave, and an optical maser may be used.

The subject of treatment may be an animal other than a human.
The purpose of excision of the intracranial tissue described above may be other than treatment. For example, an intracranial tissue such as a tumor may be removed for research or educational purposes.
The liquid to be ejected may be biocompatible as long as it is not physiological saline. For example, pure water or chemicals may be used.
The robot may perform at least some of the steps in the ablation method.
The trocar may function as a pressure release tube.

DESCRIPTION OF SYMBOLS 10 ... Liquid ejecting apparatus 10a ... Liquid ejecting apparatus 10b ... Liquid ejecting apparatus 30 ... Pulsating flow generation unit 31 ... Pulsating flow generation part 32 ... Diaphragm 33 ... Piezoelectric element 34 ... 1st case 36 ... 2nd case 38 ... 3rd case 39 ... Reinforcing member 42 ... Liquid chamber 50 ... Liquid supply mechanism 51 ... Flow path 52 ... Flow path 53 ... Connection flow path 55 ... Injection pipe 55b ... Injection pipe 59 ... Liquid container 70 ... Control device 70a ... Control device 71 ... Signal line 72 ... Signal wire 75 ... Foot switch 80 ... Hand piece 100 ... Endoscope 110 ... Insertion part 113 ... Soft part 115 ... Bending part 120 ... Tip part 121 ... Light 122 ... Object lens 123 ... Air supply / water supply port 124 ... Intake water intake port 125 ... Opening part 130 ... Connection flow path insertion port 140 ... Holding part 150 ... Operation part 160 ... Connection part 190 ... Stopper 300 ... Trocar 10 ... second trocar 400 ... pressure sensor 410 ... pressure detection unit 500 ... accumulator 600 ... pressure release tube C ... ventricles T ... tumor V ... vessels

Claims (8)

Inserting a jet tube into the skull;
A method of excision of intracranial tissue, the method comprising: ejecting a liquid having biocompatibility and imparted with a pulsating flow from the ejection tube to excise the tissue in the skull. The intracranial tissue excision method according to claim 1, wherein in the excision step, the flow rate of the liquid ejected per unit time is controlled based on the pressure in the skull. The intracranial tissue excision method according to claim 1 or 2, wherein, in the excision step, fluctuations in pressure in the skull are alleviated. The intracranial tissue excision method according to claim 3, wherein the relaxation is realized by an accumulator inserted into the skull. The intracranial tissue excision method according to claim 3 or 4, wherein the relaxation is realized by a tube for discharging the liquid in the skull to the outside. Inserting a conduit into the skull;
Passing an endoscope through the conduit after insertion of the conduit;
The intracranial tissue according to any one of claims 1 to 5, wherein the step of inserting the ejection tube is a step of inserting the ejection tube into the conduit after the step of passing through the endoscope. Resection method. A conduit insertion step of inserting first and second conduits into the skull;
Passing an endoscope through the first conduit after insertion of the first conduit;
6. The step of inserting the injection pipe is a step of inserting the injection pipe into the second conduit after the insertion of the second conduit. 6. Of excision of intracranial tissue.   A treatment method using the intracranial tissue excision method according to any one of claims 1 to 7.

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