改良 Paine 点脑室穿刺协助治疗早期破裂颅内多发动脉瘤

Improved Paine point ventricular puncture in the assisted treatment of early ruptured intracranial multiple aneurysms

目的：探讨早期颅内多发动脉瘤破裂出血后的显微手术方法。方法选取23例颅内多发动脉瘤患者，经翼点开颅，均在发病72 h 内手术，经改良 Paine 点脑室穿刺放出脑脊液后，急诊显微手术夹闭破裂的颅内动脉瘤49个，包裹2个。结果23例开颅手术患者共成功夹闭动脉瘤50个（其中一次夹闭3个动脉瘤2例，1次夹闭2个动脉瘤15例，1次夹闭1个动脉瘤加包裹1个动脉瘤1例，分次夹闭4个动脉瘤1例，分次夹闭2个动脉瘤4例）。结论颅内多发动脉瘤显微手术方法复杂，改良 Paine 点脑室穿刺放出脑脊液能有效减轻早期手术时的急性脑肿胀，利于通过早期手术处理所有动脉瘤，但需要结合患者的实际情况制订个性化的手术方案，以取得较好的临床效果。

Objective To investigate the microsurgical methods for the early stage of rup-tured intracranial multiple aneurysms. Methods Twenty-three cases of intracranial multiple aneu-rysms were selected,through pterion craniotomy,all of them were operated within 72 h of attack. After the modified Paine point of the ventricle puncture cerebrospinal fluid,and emergency microsur-gical clip closed rupture of intracranial aneurysm in 49 cases,parcel in two cases. Results Twenty-three craniotomy patients were placed successfully closed 50 aneurysms（ the clipped three aneurysms in two cases,one time clipping two aneurysms in 15 cases,one time clipping one aneurysm and wrapped in one aneurysm in one case,sub clipping four aneurysms in one case,a clipping two aneu-rysms in four cases）. Conclusions Intracranial multiple intracranial aneurysm microsurgery meth-ods are complex,modified Paine ventricle puncture released cerebrospinal fluid can effectively re-duce the early operation of acute brain swelling,which is in favor of all aneurysms with early surgery treatment,but need to be combined with the actual situation of develop personalized operation plan, in order to obtain a better clinical effect.