The place where cerebrospinal fluid is produced is the lateral ventricle. In addition to the lateral ventricle, there are the third ventricle and the fourth ventricle.
The ventricular system can be called the "pool" containing cerebrospinal fluid. The cerebrospinal fluid flows from the lateral ventricle to the third ventricle and then to the fourth ventricle.
How cerebrospinal fluid is recovered is through arachnoid granules and returned to the venous system.
The above cycle sounds like a very closed environment.
That's right. The blood-brain barrier that we often hear about includes three types of barriers: blood-brain, blood-cerebrospinal fluid, and cerebrospinal fluid-brain barrier. This is evident from the fact that the cerebrospinal fluid environment is so closed.
The specific deconstruction of how "sealing" and "barrier" come about is more complicated. There are cellular interpretations and mechanical and physical interpretations.
Talking back to the current patient, he has hydrocephalus. Hydrocephalus means that there is "water" in the brain and there is too much cerebrospinal fluid. There is too much cerebrospinal fluid, which means that there may be too much "water" secreted, there may be a problem with the recycling mechanism, or the circulation path may be blocked.
, the "water" body cannot circulate smoothly, and as a result, the "pool" containing cerebrospinal fluid naturally expands.
The clinical manifestations are that CT shows expansion of the ventricular system and/or subarachnoid space, which compresses normal brain tissue and is often accompanied by brain atrophy. What are the symptoms of brain atrophy? I have just mentioned the symptoms of cerebellar atrophy, and it is only more serious than cerebellar atrophy.
Typical symptoms in adult patients: headache, nausea and vomiting, abnormal mental state, drowsiness and mania, ataxia, fecal incontinence, etc.
In view of the many issues we have discussed above about cerebrospinal fluid, we can know that if hydrocephalus is caused by other diseases, such as tumors, it may be solved with a surgical knife.
However, the cause of hydrocephalus, which is often seen in clinical patients, may not be clearly visible. If it involves a more complex secretion problem, it is naturally better to solve it with internal medicine than surgery.
If surgery does not cure the root cause of the disease and it is likely to relapse frequently, why let the patient undergo a surgery in vain?
If you have to use surgical means, you need to know the cause and it can be solved by surgery.
For example, ventriculoscopic third ventriculostomy aims at the circulation obstruction of cerebrospinal fluid in the path from the third ventricle to the fourth ventricle through the midbrain aqueduct. A hole is directly made in the third ventricle to guide the cerebrospinal fluid to the prepontine cistern.
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If the cause cannot be clarified or the cause cannot be solved with surgery, the surgeon also has a conservative surgical treatment plan, which is the most commonly used cerebrospinal fluid shunt.
Time was tight, so a group of neurosurgeons entered the ward first to conduct rounds.
Dr. Jin waited outside until they checked into his ward before going in to see them.
Starting from the last bed, we found the patient in the 23rd bed, Dr. Jin’s friend. The patient was a woman in her thirties and forties. It was initially judged that it might be hydrocephalus caused by some kind of infection, because no other symptoms could be found at the moment.
Inducement. However, after it was later discovered that there was a cerebral arteriovenous malformation, it was difficult to say which of the two came first.
The patient's current condition is relatively serious, and he has become drowsy.
A group of junior brothers and sisters came.
During the ward rounds, Huang Zhilei asked his juniors to go up and perform neurosurgical examinations on the patients, treating them as on-site examinations.
For patients with hydrocephalus, according to what Pan and his classmates think, you can't tell what the condition of hydrocephalus is by just looking at the patient's head.
If you want to thoroughly check for ataxia, the patient will be drowsy, and you want the patient to open his eyes to answer questions, etc. The patient cannot cooperate with the doctor.