微创锥颅置管引流术中硬通道与脑动脉血管网关系的探讨

Relationship of cerebral vasculature and stiff drainage tube position in Burr hole evacuation with drainage for cerebral hemorrhage

摘要:

目的 探讨应用硬通道微创锥颅置管术治疗脑出血时，穿刺路径与脑动脉血管网构筑的关系。方法 本研究对2012年4月至2014年3月在福建省晋江市医院神经内科住院的60例脑出血患者行简易立体定向电驱动锥颅置管术治疗，术后待血肿引流量＞90%后，拔管前行脑血管造影成像（CTA），以了解穿刺针及血肿穿刺路径与脑动脉血管网构筑的关系。结果 对所有脑出血患者在微创锥颅置管术后CTA分析发现，穿刺针在穿刺血肿靶点的路径中均可安全滑过相关颅脑动脉，标点穿刺针位置准确；未见置管及引流过程中穿刺针明显损伤，相关重要脑动脉血管引流效果好。患者术后恢复快，预后良好率达到61.67%。结论 硬通道微创锥颅置管术及术后引流过程中，穿刺针不易损伤脑动脉血管网，穿刺路径较安全可靠。

Abstract:

Objective To investigate the positional relationship of cerebral vasculature with path of puncture and drainage in Burr hole removal of intracranial hematoma after cerebral hemorrhage. Methods A total of 60 patients with cerebral hemorrhage undergoing stereotactic puncture and drainage of intracranial hematoma in our department from April 2012 to March 2014 were enrolled in this study. After adequate drainage of the hematoma (more than 90% of hematoma evacuation), cerebral CT angiography (CTA) was carried out before the removal of drainage tube to investigate the positional relationship between cerebral vasculature and the drainage path. Results CTA results indicated that the puncture needle and its path were safe to the surrounding cerebral arteries, the needle tip was positioned accurately, and no obvious damages were seen during the tube dwelling and drainage. All patients had adequate drainage of the hematoma and good recovery after surgery, with a rate of favorable prognosis of 61.67%. Conclusion In Burr hole evacuation with stiff drainage tube of intracranial hematoma, the puncture needle is safe to cerebral vasculature, and its drainage path is safe and reliable.