What are the operation methods and precautions for anterior fontanelle puncture?

(1) Operation method: The child is placed in the supine position, and the scalp is routinely disinfected; the towel is laid, and the assistant fixes the head. The puncture point is at the outer corner of the anterior fontanelle, 1.5-2 cm away from the midline. The puncture needle can be a general puncture needle or a No. 7 lumbar puncture. After the needle is pierced into the skin, the needle tip is outward and downward, and the subdural space can be reached after entering 0.5 cm. If old blood, effusion, or pus is aspirated, the needle tip should be secured to prevent it from being too deep or prolapsed, and then slowly aspirated or drained continuously. When doing ventricle puncture, the puncture needle enters the skin and then penetrates vertically, and the needle can penetrate into the ventricle after 3 to 4 cm. In children with severe hydrocephalus with extremely enlarged ventricles, it is easy to enter the ventricle during puncture. (2) Precautions 1) When the pus is extracted by subdural puncture, it is strictly forbidden to penetrate deeply or perform ventricular puncture, so as to prevent the infection from spreading to the inside. 2) When repeated ventriculocentesis is required for decompression, care should be taken to replace the puncture point to reduce the chance of bleeding. 3) When performing continuous ventricular drainage, the puncture needle and drainage tube must be properly fixed after successful puncture to prevent the needle from shaking and damaging the brain parenchyma.

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