Definitely have to face it head on.
If he didn't dare to fight, Song Xuelin would definitely look at them like that again: Just you? Do you think you are in the same class as Xie?
Raising his head, Pan Shihua faced the monitor screen, his eyes locked on the area where the surgeon was scanning again, and said: "From the current picture, the direction of the cerebrospinal fluid in this place shows signs of a slow vortex and spinning in place. It shows that in The flow rate below is not smooth. The trumpet-shaped outlet of the midbrain aqueduct that Yingying mentioned actually refers to the expansion of the outlet end of the midbrain aqueduct after the fourth ventricle is dilated."
"It turns out that the midbrain aqueduct originally grew into a trumpet-shaped abnormality, is it like this?" Sun Yubo, who is not a neurosurgery specialist, asked. When he first heard about it, he thought it was the cause of the disease, but now it doesn't sound like it.
Mainly because his fellow countryman Huang Daxia didn't come out immediately to explain whether it was true or not.
In anatomy, if you look at an anatomical atlas, you will find that the midbrain aqueduct is a long, slender tube with a twist inside, unlike the lateral ventricle to the third ventricle, which just passes through a hole like the interventricular foramen. This structure makes it difficult for the hard mirror we mentioned before to pass through, so you can only use a soft mirror to slowly twist it like an earthworm or a caterpillar.
As Pan said, if there is too much water in the fourth ventricle connected to the bottom of this long thin tube, the water will overflow and flow upward, stretching the lower end of the tube together. The outlet of the enlarged tube will naturally be shaped like a trumpet.
In this case, is it possible that something in the fourth ventricle is blocked near the outlet of the midbrain aqueduct? As mentioned before, no space-occupying obstruction was found in this case. It has been determined to be a communication obstruction. It is more likely to be a problem in the cerebral subarachnoid space below the fourth ventricle.
The cerebral subarachnoid space is the space between the pia mater and the arachnoid mater, so it is very confusing to say that it is a cavity, making people think that it is a cavity similar to the oral cavity, but it is not. To be more precise, it is a water network extending in all directions, covering canals and pools. The canals are spread throughout the sulci and fissures of the brain. The larger places are called pools and are usually called cerebral cisterns.
This water network receives the cerebrospinal fluid from the fourth ventricle, allowing the cerebrospinal fluid to spread throughout the brain and function. At the same time, the subarachnoid space of the brain is connected to the subarachnoid space of the spinal cord, allowing cerebrospinal fluid to continue to flow to the spinal cord. The cerebrospinal fluid flowing out from the subarachnoid space after spinal anesthesia is punctured as we talked about comes from here.
ETV surgery is to create a fistula in the bottom of the third ventricle, that is, to make a hole to allow cerebrospinal fluid to flow directly into the lower brain pool to solve the problem of cerebrospinal fluid accumulation.
From the above, we can know that the focus of this operation should be on the cause of proximal ventricular obstruction. This means that if hydrocephalus is caused by poor outflow from the fourth ventricle to the prepontine cistern, it does not necessarily have to be a space-occupying obstruction. For example, some other factors may have narrowed this subarachnoid space. The shunt created at this time can allow the cerebrospinal fluid in the ventricle to flow directly around the obstructed segment to the cerebral cistern to continue circulation, which is of course effective.
All neurosurgery specialists know this.
It was impossible for Huang Zhilei not to know. He glanced at Dr. Sun Yubo, a fellow non-neurosurgery specialist: "If you don't understand, don't talk nonsense." Just because I don't explain it doesn't mean I don't understand such a superficial knowledge point.
where is the problem? How do you judge that it is proximal ventricular obstruction rather than a problem in the subarachnoid space elsewhere?
