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 interpretations at the cellular level 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 the "water" may be secreted too much, or there may be a problem with the recovery mechanism, or the circulation path may be blocked, and the "water" body will not circulate smoothly. As a result, the "pool" containing cerebrospinal fluid will naturally expand.
Clinical manifestations: CT shows dilation of the ventricular system and/or subarachnoid space, which compresses normal brain tissue and is often accompanied by brain atrophy. What is the disease of brain atrophy? As mentioned earlier, the symptoms of cerebellar atrophy are only more serious than cerebellar atrophy.
Typical symptoms: headache, nausea and vomiting in adult patients, abnormal mental state, drowsiness and mania, ataxia, fecal incontinence, etc.
In view of the fact that we have talked a lot about cerebrospinal fluid issues above, 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 commonly seen in clinical patients, may not be clearly visible. If more complex secretion problems are involved, it is naturally better to solve them with internal medicine rather than surgery.
If surgery does not cure the root cause, there is a risk that the disease will relapse frequently, so why let the patient undergo a surgery in vain?
If you have to use surgical means, you need to make sure that the cause of the disease can be solved by surgery.
For example, ventriculoscopic third ventriculostomy targets the circulation obstruction of cerebrospinal fluid in the path from the third ventricle through the midbrain aqueduct to the fourth ventricle. A hole is made directly in the third ventricle to direct cerebrospinal fluid to the prepontine cistern.
If the cause cannot be clarified or the cause cannot be solved with surgery, surgery also has a conservative treatment plan, the most common one being cerebrospinal fluid shunting.
Time was tight, so a group of neurosurgeons entered the ward for rounds first.
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. The initial judgment is that hydrocephalus may be caused by some kind of infection, because no other triggers can be found for the time being. However, after a cerebral arteriovenous malformation was later discovered, 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 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.
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