側腦室穿刺Paine點改良的解剖基礎及臨床應用_《華西醫學》

作者：

乞紹嵐 ¹ , 張曉東 ² , 李擴 ² , 鮑剛 ² , 徐高峰 ² ,  李瑞春 ²

1 富平縣第二人民醫院神經外科（陜西富平，711700）;2 西安交通大學醫學院第一附屬醫院神經外科;

關鍵詞：

翼點入路腦室穿刺解剖應用

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

【摘要】　目的　研究改良Paine點側腦室額角穿刺的解剖基礎及臨床應用。　方法　利用MRI模型的構建，模擬改良Paine點穿刺側腦室額角。測量穿刺距離、角度及其對Broca語言功能區和尾狀核的影響。改良Paine點（Pm點）比Paine點高1 cm，更加遠離Broca語言功能區，穿刺時需要與軸面夾角20°向下，可以越過尾狀核頭從側腦室額角上壁進入腦室；與矢狀面夾角約70°向下、冠狀面夾角約20°向后穿刺。從皮層計算進針4.0~5.5 cm可進入側腦室額角。　結果　同期7例顱內動脈瘤患者術中應用Pm點穿刺成功，術后無語言功能障礙，復查頭顱CT無穿刺道及尾狀核頭出血現象。　結論　 Pm點法定位方法簡便準確，能避免Broca語言功能區和尾狀核頭部的損傷，有一定臨床應用推廣價值。
【Abstract】　Objective　 To analyze the anatomic characteristics and clinical application of modified Paine entry point (Pm) for lateral ventricular puncture through pterional approach.　Methods　 We simulated the modified Paine entry point for lateral ventricular frontal horn puncture by reconstructing the model of MRI. Distance and angles of the puncture path were measured to evaluate the influence upon the language areas of Broca and the head of the caudate nucleus. The Pm point is 1 cm higher than the Paine point, so it is more far away from the Broca area. The direction of the puncture path should be 20° downward with the axial plane, 70° downward with the sagittal plane and 20° backward with the coronal plane. The catheter was inserted into the ventricle 4.0 to 5.5 cm deep to the cortex.　Results　 Seven patients with intracranial aneurysms underwent ventricular puncture successfully through the Pm point in operation. None of them suffered language dysfunction or hemorrhage lesions in the caudate nucleus by the computed tomography.　Conclusion　 The modified Paine entry point can be located accurately and has the clinical value for preventing damage of the Broca area and the caudate nucleus.

引用本文： 乞紹嵐,張曉東,李擴,鮑剛,徐高峰,李瑞春. 側腦室穿刺Paine點改良的解剖基礎及臨床應用. 華西醫學, 2011, 26(8): 1153-1155. doi: 復制

1.	Paine JT, Batier HH, Samson D. Intraoperative ventricular puncture[J]. Neurosurgery, 1988, 22(6): 1107-1109.
2.	王忠誠. 神經外科學[M]. 武漢: 湖北科學技術出版社, 2004: 765.
3.	顧字翔, 毛穎, 宋冬霄, 等. 腦前循環動脈瘤破裂早中期的顯微外科手術治療[J]. 中華外科雜志, 2006, 44(3): 412-415.
4.	Fleck JD, Biller F, Loftus CM. Surgical techniques for intracranial aneurysms//Grossman RG,Loftus G. Principle of Neurosuegery[M]. 2nd ed. Philadelphia: Lippincott-Raevn Pubilshers, 1999: 311-337.
5.	Batjer H, Kopitnik T, Gilier C, et al. Surgery for paraclinoidal artery aneurysms[J]. J Neurosurg, 1994, 80(4): 650-658.
6.	Knosp E, Muller G, Perneczky A. The paracliniod carotid artery: Anatomical aspects of a microneurosurgical approach[J]. Neurosurgery, 1988, 22(5): 896-901.
7.	Chyatte D, Nicolee C, Thoralf M, et al. Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage[J]. J Neurosurg, 1988, 69(3): 326-331.
8.	Suzuki J, Yoshimoto T, Hori S. Continuous ventricular drainage to lessen surgical risk in ruptured intracranial aneurysm[J]. Surg Neur, 1974, 2(2): 87-90.
9.	Sharma BS, Gupta A, Ahmad FU, et al. Surgical management of giant intracranial aneurysms. Clin Neurol Neurosurg, 2008 110(7): 674-81.
10.	MG Yasargil. Microneurosurgery[M]. New York: Georg Thieme Verlag Stuttgart, 1984: 71-108.
11.	Tominaga J, Shimoda M, Oda S, et al. MR imaging findings after ventricular puncture in patients with SAH[J]. Acta Neurochirurgica, 2001, 143(11): 1133-1140.
12.	Rhoton AL Jr. The cerebrum[J]. Neurosurgery, 2002, 51(Suppl 4): 1-51.

1. 　Paine JT, Batier HH, Samson D. Intraoperative ventricular puncture[J]. Neurosurgery, 1988, 22(6): 1107-1109.
2. 　王忠誠. 神經外科學[M]. 武漢: 湖北科學技術出版社, 2004: 765.
3. 　顧字翔, 毛穎, 宋冬霄, 等. 腦前循環動脈瘤破裂早中期的顯微外科手術治療[J]. 中華外科雜志, 2006, 44(3): 412-415.
4. 　Fleck JD, Biller F, Loftus CM. Surgical techniques for intracranial aneurysms//Grossman RG,Loftus G. Principle of Neurosuegery[M]. 2nd ed. Philadelphia: Lippincott-Raevn Pubilshers, 1999: 311-337.
5. 　Batjer H, Kopitnik T, Gilier C, et al. Surgery for paraclinoidal artery aneurysms[J]. J Neurosurg, 1994, 80(4): 650-658.
6. 　Knosp E, Muller G, Perneczky A. The paracliniod carotid artery: Anatomical aspects of a microneurosurgical approach[J]. Neurosurgery, 1988, 22(5): 896-901.
7. 　Chyatte D, Nicolee C, Thoralf M, et al. Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage[J]. J Neurosurg, 1988, 69(3): 326-331.
8. 　Suzuki J, Yoshimoto T, Hori S. Continuous ventricular drainage to lessen surgical risk in ruptured intracranial aneurysm[J]. Surg Neur, 1974, 2(2): 87-90.
9. 　Sharma BS, Gupta A, Ahmad FU, et al. Surgical management of giant intracranial aneurysms. Clin Neurol Neurosurg, 2008 110(7): 674-81.
10. 　MG Yasargil. Microneurosurgery[M]. New York: Georg Thieme Verlag Stuttgart, 1984: 71-108.
11. 　Tominaga J, Shimoda M, Oda S, et al. MR imaging findings after ventricular puncture in patients with SAH[J]. Acta Neurochirurgica, 2001, 143(11): 1133-1140.
12. 　Rhoton AL Jr. The cerebrum[J]. Neurosurgery, 2002, 51(Suppl 4): 1-51.

《華西醫學》

側腦室穿刺Paine點改良的解剖基礎及臨床應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《華西醫學》

側腦室穿刺Paine點改良的解剖基礎及臨床應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料