改良Paine点穿刺脑室外引流术及终板造瘘术在颅内前循环破裂动脉瘤急性期夹闭术中的应用  

Application of extraventricular drainage through modified Paine point puncture and lamina terminalis fenestration during clipping ruptured intracranial anterior circulation aneurysms at acute stage

作　　者：张道宝 陈舒[1] 吴虹刚[1] 游国亮 雷波[1] 万晓强[1] 郑念东[1] ZHANG Dao-bao;CHEN Shu;WU Hong-gang;YOU Guo-liang;LEI Bo;WAN Xiao-qiang;ZHENG Nian-dong(Department of Cerebrovascular Diseases,The People's Hospital of Leshan City,Leshan 614000,China)

机构地区：[1]乐山市人民医院脑血管病科,四川614000

出　　处：《中国临床神经外科杂志》2021年第7期527-528,570,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨Paine点穿刺脑室外引流术及终板造瘘术在颅内前循环动破裂脉瘤急性期夹闭术中的应用效果。方法回顾性分析2017年1月至2019年12月急性期显微夹闭治疗的85例颅内前循环破裂动脉瘤的临床资料,术中采用Paine点穿刺脑室外引流术及终板造瘘术。结果85例中,81例改良Paine点穿刺顺利,4例穿刺失败;11例因动脉瘤夹闭后仍见脑组织塌陷不佳,行终板造瘘术,并保留脑室外引流3~5 d,其中3例行去骨瓣减压术。术后复查CTA或DSA,4例前交通动脉动脉瘤、5例大脑中动脉动脉瘤的瘤颈有少许残留,其余动脉瘤均夹闭完全。术后随访半年,8例失访,其余77例复查CTA未见动脉瘤复发;GOS评分5分72例,4分3例,3分2例;1例出现脑积水并行脑室-腹腔分流术。结论颅内前循环破裂动脉瘤急性期夹闭术中,改良Paine点穿刺脑室外引流术、终板造瘘术有利于充分释放脑脊液,降低颅内压,充分暴露动脉瘤,改善夹闭术治疗的效果。Objective To explore the clinical efficacy of extraventricular drainage through modified Paine point puncture(EVDP)and lamina terminalis fenestration(LTF)during clipping the ruptured intracranial anterior circulation aneurysms(r-IACA)at acute stage.Methods The clinical data of 85 patients with r-IACA who underwent clipping assissted by intraoperative EVD-P and LTF at acute stage between January 2017 and December 2019 were analyzed retrospectively.Results EVD-P was successfully performed on 81 patients and failed in 4.LTF with extraventricular drainage for 3~5 days was performed on 11 patients,of whom 3 underwent decompression,due to poor brain tissue collapse after aneurysm clipping.Postoperative CTA or DSA showed few neck residues in 4 patients with anterior communicating artery aneurysm and 5 patients with middle cerebral artery aneurysm,and complete occlusion of aneurysm in other 77 patients.The 6-month follow up of 77 patients showed no reccurrence,and GOS score of 5 in 72 patients,score of4 in 3 and score of 3 in 2.Conclusions During clipping the r-IACA at acute stage,EDV-P and LTF are helpful to improving the patients’prognoses by fully release of cerebrospinal fluid,reduce in intracranial pressure,and fully exposure of aneurysm.

关 键 词：颅内破裂动脉瘤 前循环 显微夹闭术 Paine点穿刺脑室外引流术 终板造瘘术 疗效 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]