【摘要】 目的 研究改良Paine点侧脑室额角穿刺的解剖基础及临床应用。 方法 利用MRI模型的构建，模拟改良Paine点穿刺侧脑室额角。测量穿刺距离、角度及其对Broca语言功能区和尾状核的影响。改良Paine点（Pm点）比Paine点高1 cm，更加远离Broca语言功能区，穿刺时需要与轴面夹角20°向下，可以越过尾状核头从侧脑室额角上壁进入脑室；与矢状面夹角约70°向下、冠状面夹角约20°向后穿刺。从皮层计算进针4.0~5.5 cm可进入侧脑室额角。 结果 同期7例颅内动脉瘤患者术中应用Pm点穿刺成功，术后无语言功能障碍，复查头颅CT无穿刺道及尾状核头出血现象。 结论 Pm点法定位方法简便准确，能避免Broca语言功能区和尾状核头部的损伤，有一定临床应用推广价值。【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.
目的:研究微创侧脑室穿刺联合置管外引流术治疗脑室出血的疗效。方法:将我院48例脑室出血患者随机分为治疗组及对照组,对照组采用常规内科药物治疗,治疗组在对照组基础上采用微创侧脑室穿刺联合置管外引流术。结果:治疗组的总有效率为83.33%,显著高于对照组的50.0%,死亡率显著低于对照组,以上差异有统计学意义(Plt;0.05)。结论:微创侧脑室穿刺联合置管外引流术治疗脑室出血效果好,损伤小、操作简便易行,缩短了病程,显著降低了患者致残率及死亡率,及早手术,可提高治愈率和生存质量,值得推广。