眶上锁孔入路术中侧脑室穿刺的研究

The study of intra-operative ventricular puncture during supraorbital craniotomy

目的经眉弓眶上锁孔入路手术经常出现术中脑肿胀的情况,影响手术进一步操作,通过术中侧脑室穿刺释放脑脊液可有效解决该问题。本文通过分析正常人的磁共振图像(MRI),尝试对眶上锁孔入路术中侧脑室穿刺的位点和穿刺角度、深度进行研究,提高侧脑室穿刺的准确性和成功率,减少手术创伤。方法本文随机选取了2014年1月至2014年6月于青岛大学附属医院就诊的48名无颅内疾病和脑室异常者的MRI图像。采用关键孔上方沿颞上线1 cm处作为穿刺点,利用GE Medical Systems的Centricity Enterprise Web 3. 0软件分别测量以下极值:水平面中穿刺道与中线夹角的角度;矢状面中穿刺道与下眶听线夹角的角度;穿刺道的长度;实际穿刺长度的确定。结果以关键孔上方沿颞上线1 cm处脑皮质作为穿刺点,穿刺道与中线夹角平均值为45. 3°(44. 2°～46. 5°),与下眶听线夹角平均值为14. 5°(11. 9°～17. 1°),穿刺深度距脑皮质最少3. 5 cm,最大不超过6. 8 cm。修正后的实际穿刺道长度为3. 6～7. 0 cm。结论在眶上锁孔入路手术术中需进行侧脑室穿刺时,术者往往根据个人经验进行脑室穿刺,且选取穿刺点不一,误差难免较高,以本研究所采用的穿刺点和穿刺角度进行穿刺是简易、可行的。

Objective Supraorbital keyhole surgery often encounters intra-operative brain swelling,which may be effectively solved by the release of cerebrospinal fluid through intra-operative lateral ventricle puncture.Based on the analysis of normal MRI,the ventricle puncture site and puncture angle,depth of supraorbital keyhole surgery were analyzed,and the accuracy of the lateral ventricle puncture was improved,and the surgical trauma was reduced.Methods A total of48MR images of the patients with no pathological cerebral characteristics or ventricular distortion from January2014to June2014in the Affiliated Hospital of Qingdao University were collected.Using key hole along the temporal line1cm above as the puncture point,GE Medical Systems Centricity Enterprise Web3.0software was used to measure its extremum:puncture catheter and the angle of the midline in the horizontal plane;puncture catheter and the angle of the orbitomeatal line in the horizontal plane;the length of the puncture way;actual puncture length and the deviation of the theoretical value.Results Use the cortex under key hole along the temporal line1cm above as the puncture point,the averages angle of the catheter to the midline was45.3°(44.2°~46.5°),the averages angle of the catheter to the orbitomeatal line was14.5°(11.9°~17.1°),the puncture depth from the cerebral cortex was at least3.5cm,not more than6.8cm.The revised actual puncture length was3.6cm to7.0cm.Conclusion Usually in supraorbital keyhole surgery,if lateral ventricle puncture is necessary,the performer is often based on personal experience,so the errors might be unavoidable.Using this technique,the lateral ventricle can be easily tapped.The landmark required for this technique is readily available in all patients.