Anatomic Analysis and Clinical Application of Modified Paine Entry Point for Lateral Ventricular Frontal Horn Puncture_West China Medical Journal

Authors：

QI Shaolan ¹ , ZHANG Xiaodong ² , LI Kuo ² , BAO Gang ² , XU Gaofeng ² ,  LI Ruichun ²

1. Neurosurgical Department of the Second People′s Hospital of Fuping County, Fuping, Shaanxi 711700, P. R. China; 2. First Affiliated Hospital of Medical College of Xi′an Jiaotong University, Xi′an, Shaanxi, P. R. China;

Corresponding author：

LI Ruichun, Email: 937197883@qq.com

Keywords：

翼点入路; 脑室穿刺; 解剖; 应用

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【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.

Citation： QI Shaolan,ZHANG Xiaodong,LI Kuo,BAO Gang,XU Gaofeng,LI Ruichun. Anatomic Analysis and Clinical Application of Modified Paine Entry Point for Lateral Ventricular Frontal Horn Puncture. West China Medical Journal, 2011, 26(8): 1153-1155. doi: Copy

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1. 　Paine JT, Batier HH, Samson D. Intraoperative ventricular puncture[J]. Neurosurgery, 1988, 22(6): 1107-1109.
2. 　王忠诚. 神经外科学[M]. 武汉: 湖北科学技术出版社, 2004: 765.
3. 　顾字翔, 毛颖, 宋冬霄, 等. 脑前循环动脉瘤破裂早中期的显微外科手术治疗[J]. 中华外科杂志, 2006, 44(3): 412-415.
4. 　Fleck JD, Biller F, Loftus CM. Surgical techniques for intracranial aneurysms//Grossman RG,Loftus G. Principle of Neurosuegery[M]. 2nd ed. Philadelphia: Lippincott-Raevn Pubilshers, 1999: 311-337.
5. 　Batjer H, Kopitnik T, Gilier C, et al. Surgery for paraclinoidal artery aneurysms[J]. J Neurosurg, 1994, 80(4): 650-658.
6. 　Knosp E, Muller G, Perneczky A. The paracliniod carotid artery: Anatomical aspects of a microneurosurgical approach[J]. Neurosurgery, 1988, 22(5): 896-901.
7. 　Chyatte D, Nicolee C, Thoralf M, et al. Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage[J]. J Neurosurg, 1988, 69(3): 326-331.
8. 　Suzuki J, Yoshimoto T, Hori S. Continuous ventricular drainage to lessen surgical risk in ruptured intracranial aneurysm[J]. Surg Neur, 1974, 2(2): 87-90.
9. 　Sharma BS, Gupta A, Ahmad FU, et al. Surgical management of giant intracranial aneurysms. Clin Neurol Neurosurg, 2008 110(7): 674-81.
10. 　MG Yasargil. Microneurosurgery[M]. New York: Georg Thieme Verlag Stuttgart, 1984: 71-108.
11. 　Tominaga J, Shimoda M, Oda S, et al. MR imaging findings after ventricular puncture in patients with SAH[J]. Acta Neurochirurgica, 2001, 143(11): 1133-1140.
12. 　Rhoton AL Jr. The cerebrum[J]. Neurosurgery, 2002, 51(Suppl 4): 1-51.

West China Medical Journal

Anatomic Analysis and Clinical Application of Modified Paine Entry Point for Lateral Ventricular Frontal Horn Puncture

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