侧脑室穿刺（Lateral ventricular puncture）

侧脑室穿刺（Lateral ventricular puncture） 侧脑室穿刺(Lateral ventricular puncture) The role of lateral ventricle puncture and drainage in hypertensive intracerebral hemorrhage Department of Neurosurgery, 177 Hospital of Guangdong Province: Li Zhichao, Wu Xiangzhen, Huang Zanjun, Lin Wupeng, 2003-12-01 Lateral ventricle puncture and drainage is very important in the treatment of hypertensive intracerebral hemorrhage. It is divided into six aspects as follows: I. The therapeutic significance of ventricular external drainage First, cerebrospinal fluid can be directly removed from the intracranial, effectively relieve intracranial pressure, and help to pass the dangerous period of intracranial hypertension. Two, it can effectively eliminate the accumulation of blood in the lateral ventricle and the three ventricle, and open the cerebrospinal fluid circulation channel as soon as possible, so as to effectively treat and prevent the occurrence of obstructive hydrocephalus in the acute stage of hypertensive intracerebral hemorrhage. Three to accelerate the evacuation of the hematoma into the ventricles of the brain (thalamus hemorrhage, basal ganglia hematoma, into the ventricles of the brain). Four through the puncture needle to minimally invasive intracerebroventricular injection of urokinase, accelerate subarachnoid hematocele emptying, reduce days after obstructive hydrocephalus or the incidence of injection; dexamethasone containing trace amounts of saline to the positive role in the treatment for intraventricular hemorrhage caused by central high fever up. Two 、 methods of external ventricular drainage and their respective advantages and disadvantages Drilling and drainage Strengthen local anesthesia or general anesthesia has the advantages of drilling, placed diameter 1.5mm 3.0mm silicon rubber hose, direct: electrocautery incision of dura mater, when the ventricle of mild and moderate expansion, can appear for the first time puncture of lateral ventricle is not successful, then adjust the direction to wear to the lateral ventricle puncture, until now, to improve the success rate of puncture; Disadvantages: it is difficult to operate. It must be performed by a surgeon in the operation room. In addition, the silicone tube should not be injected with drugs, can not carry out intraventricular circulation irrigation, liquefaction of intraventricular blood clots. Two cranial drainage Under local anesthesia, the 1.5mm 3.0mm silicone tube is placed in the cranial cavity, which is suitable for the enlargement of the ventricles at the middle level. Besides the easy operation, the other advantages and disadvantages are basically the same as drilling drainage. Three YL - 1 minimally invasive needle puncture and drainage Under local anesthesia, needle drilling, one step in place. Advantage: 1. is conducive to intraventricular hemorrhage of cerebrospinal fluid and cerebrospinal fluid drainage; 2. can effectively maintain unobstructed drainage; 3., it can carry out the circulation, irrigation and liquefaction of intraventricular hematoma, and accelerate the evacuation of hematoma; 4. puncture hole sealing performance is good, greatly reduce the intracranial and puncture needle mouth infection opportunities. Shortcoming Because the needle is hard when the drainage channel, after lateral ventricle enlargement becomes small, the needle may not like silicone hose with smaller ventricles and change its position, and drainage tube in the ventricles, and make it possible to displace ventricle puncture needle, causing additional damage outside the ventricle slightly. In conclusion, the lateral ventricles, three intraventricular hemorrhage or cerebrospinal fluid circulatory obstruction caused by various reasons should be considered as intraventricular puncture and drainage. Four 、 ventricular drainage operation method Routine puncture method The amount of the method The puncture point selected in front of 1 cm in the coronal suture, midline 2-2.5 cm (or hair after 2 cm, 2-2.5 cm midline), parallel puncture direction and sagittal alignment, two canal imaginary line direction of the puncture depth is usually less than 5 cm. Indications for extra ventricular drainage The lateral ventricle hemorrhage, the hematoma was cast; The thalamus and basal ganglia hematoma, hematoma broken into the lateral ventricle, three ventricle; Cerebellar hemorrhage, hematoma broken into the four ventricle, three ventricle and lateral ventricle; The large area of brainstem hemorrhage, leading to obstruction of cerebrospinal fluid circulation; Hematoma of aqueduct. Because it is hard when the channel, intracranial hematoma, intracranial pressure eased, brain pulsation recovery, clinical can often be seen on the long time from puncture needle draining hemorrhagic cerebrospinal fluid (wash water meat), not on time handsetting. Mislead physicians In conclusion, it is better to measure the advantages and disadvantages, to clear the intraventricular hematoma, or to use the minimally invasive needle, for example, for cerebrospinal fluid drainage alone, or for the skull and silicone tube. Two occipital approach The puncture point in the occipital protuberance on 6-7 cm, 3 cm midline, Parallel to the puncture direction and sagittal alignment, superciliary ridge direction of puncture, puncture depth of not more than 5-6 cm. Five. The treatment of intraventricular hematoma and ventricular drainage Evacuation of hematoma in one ventricle The removal of the hematoma suction liquid, flushing, where bilateral ventricle drainage, as to flushes between two puncture needle; The injection of liquid agent, to remove blood clots after liquefaction Liquefaction agent can only use urokinase, 20 thousand units per time, 2 hours closed, and then open drainage 1-2 hours, repeated liquefaction every day, drainage 3-5 times, and strive to clean up intraventricular hematoma in 3-4 days; Main points of outdoor drainage treatment for two brain The attention maintains the patency of ventricular drainage, by suction, washing, drainage and other methods by hand squeezing out; The drainage tube or the drainage bag to raise 5-15 cm, maintain certain intracranial pressure; Open drainage of cerebrospinal fluid, to prevent a large number of short-term loss caused by low intracranial pressure, intracranial pressure and intraventricular gas; We need 5-6 days after drainage, closed tube for 24 hours, no increased intracranial pressure to extubation; Three CT positioning puncture The lateral ventricle enlargement, obvious displacement of cases, must use CT marker localization method of preoperative localization, and determine the puncture plane, the expansion of the anterior horn of lateral ventricle or occipital horn puncture center as the target, according to the positioning method to locate the intracranial hematoma puncture, according to the positioning and direction, in order to ensure puncture success. The extubation, wound sewing needle, to prevent the leakage of cerebrospinal fluid and wound into the intracranial infection by; Where will the patency of the external ventricular drainage, drainage during the period with dehydrants, extubation day before or after extubation should be combined with dehydration drugs, in order to maintain the smooth transition of intracranial pressure; Every 24 hours during the closed tube, significantly increased intracranial pressure, may prolong the indwelling time, after extubation significantly increased intracranial pressure, CT showed ventricular enlargement, the use of dehydration drugs should be considered invalid, the other place to survive the cranial cerebral ventricular drainage, Danger! High Voltage. Six. Complications of ventricular drainage A small slice of hemorrhage or small hematoma in the brain around the puncture needle. The puncture needle is too deep to injure the brain tissue; "Dependence" phenomenon of drainage of the two ventricle There are very few patients with intraventricular hematoma is cleared, cerebrospinal fluid circulation channel is opened, when the patency of the open drainage of ventricle, intracranial pressure in patients with normal, stable vital signs, once closed tube for 24 hours when the patients symptoms, making it difficult to remove the tube, I think this may be a "dependent" phenomenon the solution is, the drainage tube is gradually increased to 20-25 cm of water, let it have a gradual process of adaptation, the intracranial pressure relief from the "dependency", and strive to prolong drainage time around 3-5 days to solve this problem, where the science here does not solve the problem, only the removal of the original drainage tube. Another was a new drainage, or ventriculoperitoneal shunt. Three puncture needle mouth and intracranial infection All cases of intracranial infection are treated according to the infection requirement. Here is a treatment for this infection, for your reference. Where the occurrence of intracranial infection and intraventricular infection, should in principle be removed ventricle drainage, as the saying goes, "close the door to a more favorable, and CSF bacterial culture, choose sensitive antibiotics, this is one of the most basic processing steps; At the same time using strong antibiotics -- Fortum 1 grams of intravenous injection, once every 6 hours, every day for a total of 4 grams, a lumbar puncture, with fine needle, slow release of 10 ml CSF, then injected amikacin half, for 3-5 days, and the release of cerebrospinal fluid glucose, chloride detection, a no improvement in intracranial infection was observed, improved to a lumbar puncture for two days, this is the two step. In general, most can achieve the purpose of controlling intracranial infection.