Risks of brain puncture

Brain puncture is a surgery with relatively high risks, so we need to choose a hospital with advanced brain disease treatment to conduct the examination. Moreover, brain puncture is mainly used to examine brain diseases, and we need to diagnose whether there is brain obstruction, etc. The operation of brain puncture surgery is to insert a thin needle into the skull through the lateral angle of the anterior fontanelle to puncture the lateral ventricle, which can treat symptoms such as hydrocephalus in time.

Indications

The lateral ventricle is punctured through the skull or through the lateral angle of the anterior fontanelle in infants and young children.

1. For diagnosis

(1) Measure intraventricular pressure, perform intraventricular intracranial pressure monitoring, and examine cerebrospinal fluid composition.

(2) Perform lumbar puncture at the same time to determine whether there is obstruction in the ventricular system.

(3) Perform ventriculography.

(4) Phenolsulfonphthalein or indigo carmine is injected into the ventricle, and the nature of the hydrocephalus is determined by the time when the pigment appears during lumbar puncture or the amount of phenolsulfonphthalein excreted in the urine.

(5) During posterior cranial fossa surgery, indigo carmine is injected into the cerebral ventricle to determine whether the cerebral aqueduct is open.

2. For treatment

(1) When obstructive hydrocephalus, increased intracranial pressure, brain herniation, or other dangerous conditions occur, ventricular puncture should be performed promptly.

(2) Although dehydration drugs are used after craniotomy or posterior cranial fossa surgery, brain tension is still very high. If it is difficult to cut the dura mater, ventricular puncture should be performed to reduce pressure.

(3) In cases of purulent ventriculitis, when the cerebrospinal fluid is purulent and drug control is difficult, ventricular puncture should be performed, and the ventricle should be repeatedly flushed with large amounts of saline, followed by injection of antibiotics.

(4) Perform ventricular drainage or lateral ventricle-cerebellomedullary cisterna magna, internal jugular vein, peritoneal cavity, etc. shunt.

Methods and content

Anterior horn puncture

Mark the intersection of the coronal suture or 2 cm inside the hairline and 2.5 cm from the midsagittal line, and drill a hole with a skull awl or skull drill to reach the dura mater after local anesthesia. Insert the puncture needle through the drill hole in a direction parallel to the sagittal plane, with the needle tip pointing backward and downward, aiming at the line connecting the external auditory canals on both sides. Insert 5-6 cm to enter the anterior horn of the lateral ventricle (infants and young children can be inserted through the lateral corner of the anterior fontanelle). In emergency situations, the anterior horn can also be punctured through the forehead or orbital roof.

Posterior horn puncture

A hole was made with a skull awl or skull drill at the intersection of 6 cm above the external occipital protuberance and 3 cm lateral to the sagittal line. Point the puncture needle forward and outward, at a 15° angle to the sagittal plane, that is, toward the outer end of the eyebrow arch on the puncture side, and penetrate 5-6 cm to enter the posterior angle.

Other puncture sites

During emergency treatment of postoperative brain hernia, in order to gain time, you can also choose a bone hole in the bone flap to puncture the anterior horn, posterior horn or inferior horn of the lateral ventricle.

Precautions

Ventricular puncture is somewhat dangerous and must be performed by an experienced physician or under his guidance. During puncture, the direction and depth of puncture should be strictly controlled, the drainage speed should not be too fast, and attention should be paid to aseptic operation.