Chapter 2858 【2858】Effective Focus

Definitely head on.

If he didn't dare to fight, Song Xuelin would definitely look at them like that again: Just you? Pei claimed to be in the same class as classmate Xie?

Raising his head, Pan Shihua faced the monitor screen directly, his eyes once again locked on the area where the chief surgeon was scanning, and said: "From the current picture, the direction of the cerebrospinal fluid in this place shows a sign that the vortex is slow and spinning in place. The flow rate below this 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 expansion of the fourth ventricle.”

"So it's not that the aqueduct of the midbrain originally grew into a trumpet-shaped abnormal shape, is that so?" Sun Yubo, who is not a neurosurgery specialist, asked. When he first heard it, he thought it was such a cause, but now it doesn't sound like it.

The main reason is that his fellow Huang Daxia didn't come out immediately to explain whether it was true.

In terms of anatomy, if you look at the anatomical atlas, you will find that the aqueduct of the midbrain is a long, thin, and slightly tortuous pipe inside, unlike the lateral ventricle to the third ventricle that only passes through the interventricular foramen. Such a structure makes it difficult for the hard mirror we mentioned before to pass through. We can only use a soft mirror to twist and twist slowly like an earthworm or a caterpillar.

As classmate Pan said, the fourth ventricle connected to the bottom of this long thin tube has too much hydrocephalus and the water overflows upwards. The lower end of the tube is stretched, and the outlet of the stretched tube is naturally shaped like a trumpet.

In this case, is there something in the fourth ventricle that is blocked near the outlet of the midbrain aqueduct? As mentioned before, no space-occupying obstruction was found in this case, and it has been judged as traffic obstruction, which is more likely to be a problem in the subarachnoid space below the fourth ventricle.

The subarachnoid space is the space between the pia mater and the arachnoid, 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. More precisely, it is a network of water extending in all directions covering canals and pools. The canals are all over the sulcus and fissure of the brain. The larger places are called pools, usually called brain pools.

This water network receives the cerebrospinal fluid from the fourth ventricle, allowing the cerebrospinal fluid to spread throughout the brain. At the same time, the subarachnoid space of the brain is connected with the subarachnoid space of the spinal cord, allowing cerebrospinal fluid to continue to flow to the spinal cord. We have talked about how the puncture of spinal anesthesia to the subarachnoid space and the outflow of cerebrospinal fluid come from here.

ETV surgery is to create a fistula at the bottom of the third ventricle, that is, to drill a hole to allow the cerebrospinal fluid to flow directly into the brain pool below to solve the problem of cerebrospinal fluid stasis.

From the above, it can be known that the focus of this operation should be on the cause of proximal ventricular obstruction. It 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 space-occupying obstruction, for example, some other factors narrow the subarachnoid space. At this time, the burrowing shunt can allow the cerebrospinal fluid in the ventricle to bypass the obstructed segment and flow directly to the brain pool to continue to maintain circulation. Of course, it is effective.

Anyone who is a neurosurgeon knows this.

It is impossible for Huang Zhilei not to know, so he glanced at Dr. Sun Yubo, a non-neurosurgery fellow: You don’t understand, don’t talk nonsense. Just because I don't come out and 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 a proximal ventricular obstruction rather than a problem with the subarachnoid space elsewhere?