It must be faced head on.
If they didn't dare to fight, Song Xuelin would definitely look at them with that look again: Just you? Are you worthy of claiming that you are in the same class as Xie?
Pan Shihua raised his head and faced the monitor screen. His eyes locked onto the area the surgeon was scanning again. He said, "From the current footage, the flow of cerebrospinal fluid in this area shows signs of a slow vortex and spinning in place. This means that the flow rate is not smooth below this point. The trumpet-shaped outlet of the cerebral aqueduct that Yingying mentioned actually refers to the expansion of the outlet end of the cerebral aqueduct after the fourth ventricle expands."
"So it turns out that the cerebral aqueduct originally grew into an abnormal trumpet shape, is that right?" asked Sun Yubo, who is not a neurosurgeon. When he first heard it, he thought this was the cause of the disease, but now it doesn't sound like it.
The main thing was that his fellow villager Huang Da Xia did not come out immediately to explain whether it was true or not.
In anatomy, if you look at the anatomical atlas, you will find that the cerebral aqueduct is a long and thin tube with some twists and turns inside, unlike the lateral ventricle to the third ventricle which only passes through a hole like the interventricular foramen. This structure makes it difficult for the hard endoscope we mentioned earlier to pass through, and only a soft endoscope can be used to slowly twist and turn like an earthworm or caterpillar to pass through.
As Pan said, there is too much water in the fourth ventricle connected to this long and thin tube, and the water overflows upward, expanding the lower end of the tube. The outlet of the expanded tube naturally becomes shaped like a trumpet.
In this case, is there something in the fourth ventricle blocking the outlet of the cerebral aqueduct? As mentioned before, no space-occupying obstruction was found in this case, and it was determined to be a traffic obstruction. It is more likely that the problem is in the subarachnoid space under the fourth ventricle.
The subarachnoid space is the space between the pia mater and the arachnoid mater, so it is very misleading to call it a cavity, making people think it is a cavity space similar to the mouth, but it is not. To be more precise, it is a well-connected water network that includes canals and pools. The canals are spread throughout the sulci and fissures of the brain, and the larger areas are called pools, usually called cisterns.
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This water network receives cerebrospinal fluid from the fourth ventricle, allowing the cerebrospinal fluid to spread throughout the brain and take effect. At the same time, the subarachnoid space of the brain is connected to the subarachnoid space of the spinal cord, allowing the cerebrospinal fluid to continue to flow to the spinal cord. The cerebrospinal fluid that flows out of the subarachnoid space during spinal anesthesia puncture that we talked about comes from here.
ETV surgery involves creating a fistula at the bottom of the third ventricle, that is, making a hole to allow cerebrospinal fluid to flow directly into the cerebral cistern below to solve the problem of cerebrospinal fluid congestion.
From the above, we can know that the key to the effectiveness of this surgery should be to focus on the cause of proximal ventricular obstruction. This means that if the 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 have narrowed the subarachnoid space. At this time, the hole-drilling shunt can allow the cerebrospinal fluid in the ventricle to bypass the obstruction section and flow directly to the cistern to continue to circulate, which is of course effective.
This is something that all neurosurgeons know.
Huang Zhilei couldn't have been unaware of this, so he glanced at his fellow villager, Dr. Sun Yubo, who was not a neurosurgeon: "If you don't understand, don't talk nonsense. My failure to come out and explain doesn't mean that I don't understand such a simple knowledge point."
Where is the problem? How do you determine that it is proximal ventricular obstruction rather than a problem somewhere else in the subarachnoid space?
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