| Objective:Screened through retrospective case analysis and CT data of measurement,and Intraoperative injury of the frontal lateral ventricle puncture significantly correlated risk factors,and Intraoperative lateral ventricle puncture(IVP)problems such as the location of the process puncture drainage tube,and put forward feasible improvement measures,make more accurate Intraoperative ventricle puncture specification in order to obtain good brain relaxation and reduce puncture brain injury,improve the prognosis of patients.Methods:Collected clinical and CT measurement data of 97 patients with craniotomy clipping aneurysm who underwent lateral ventricular frontal puncture from January 2017 to October 2018 were collected.Retrospective analysis of patients’ age,gender,admission GCS score,Hunt-Hess clinical classification and grade of Fisher,infection to the operation time and location of the aneurysm 10 generally related factors,the preoperative CT in double tail index,postoperative,orbital distance space from lateral fissure and puncture depth of six operation related factors,such as puncture of degree of intraoperative brain relaxation,GOS score evaluation effectiveness and prognosis.According to whether there was injury,the patients were divided into the injury group and the non-injury group,and the differences in puncture methods between the two groups were compared.SPSS22.0 statistical software was used to conduct statistical description and analysis of the above factors,determined higher risk factors of injury,and explore the reasonable range of IVP point and improvement measures to reduce the injury.To summarize the prognostic value of intracranial pressure monitoring by catheterization.Results:Among the 97 patients undergoing intraoperative IVP puncture,there were 26 cases of injury,including 12 males and 14 females,with a ratio of 1:1.2,average age(54.15± 11.263),death and severe disability(16 cases,61.5%),and relatively good prognosis(10 cases,39.5%).Univariate analysis revealed statistically significant differences in admission GCS score,hunt-hess clinical grading,Fisher grading,preoperative smaller ventricle,distance from the lateral fissure,distance from the orbital apex,and midline deviation(P < 0.05),suggesting a risk factor for IVP injury.Further Logistic regression analysis,it was found from the lateral fissure distance(OR = 2.384,95% CI 1.106 5.137),preoperative smaller ventricles(OR = 10.232,95% CI 1.475 70.961)and Fisher classification(OR = 11.527,95% CI 2.235 59.462)of the risk factors that may occur to predict ventricle puncture injury,the nearer to the lateral fissure distance,preoperative ventricle smaller(BI < 0.14),Fisher grading the more prone to piercing damage.In this study,the recommended puncture location was 3.4cm before the lateral fissure,2.5cm above the orbital apex,and 5.0cm deep.Based on the above puncture location,the vertical brain surface puncture can reduce the injury.If the ventricle was smaller,the distance from the lateral fissure was extended by 3mm.Intracranial Pressure(ICP)monitoring had no significant difference in patients’ GOS score.Conclusion:In intracranial aneurysm clipping open IVP piercing damage is the result of multi-factors comprehensive,preoperative ventricle smaller Fisher classification is higher,the puncture point at close range from the lateral fissure for puncture injury risk factors,piercing damage can lead to poor prognosis in patients with puncture position recommended by this study is to lateral fissure before 3.4 cm,2.5 cm on the top of the orbit,the depth of 5.0 cm,with the puncture position location,vertical surface of the brain biopsy can reduce the damage,if the ventricle is hours away from lateral fissure distance extend to 3 mm. |
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