1、Welcome to Neurosurgical world!,NEUROSURGERY,by Dr. Yang,The department of Neurosurgery, the 1st hospital of Chongqing Medical University,Some words you should know,Cranium 头颅 Cerebral （大）脑的 ICP 颅内压 Foramen magnum 枕骨大孔 Brain stem 脑干 Cerebellum 小脑 Ventricle 脑室 Ventricular system 脑室系统 Choroid plexus 脉
2、络丛 Aqueduct 导水管 Lumbar puncture 腰穿 Hydrocephalus 脑积水,CSF (cerebral spinal fluid)脑脊液 Superior sagittal sinus 上矢状窦 Subarachnoid space 蛛网膜下腔 Arachnoid granulation 蛛网膜颗粒 ICP monitoring 颅内压监测 Space occupying lesion 占位性病变 Congenital malformation 先天性畸形 Nausea and Vomiting 恶心呕吐 Papilloedema 视乳头水肿,Increased
3、Intracranial Pressure (Increased ICP, Raised ICP, Intracranial Hypertension),Increased Intracranial Pressure,、 Anatomy 、 Increased Intracranial Pressure 、 Regulation of ICP 、 Pathogenesis 、 Clinical symptoms and signs 、 Diagnosis of Increased Intracranial Pressure,、 Anatomy-cranium,The cranial cavit
4、y: closed container/poorly distensible,Foramina Foramen Magnum vent,Hollow, rigid sphere with constant volume,Three contents (noncompressible),cerebral blood (75ml),CSF (75ml),brain tissue (1400ml),、 Anatomy-cranium,Cranium: no extendding; 3 components can not be compressed,、 Anatomy - Brain Tissue,
5、Cerebral hemispheres,Brain stem,Cerebellum,There are five lobi of the cerebral hemisphere, they are frontal, temporal, parietal, occipital and insular lobe.,Ventricles are just like drainage system of the brain. The shape of the ventricles is irregular. They are full of CSF,、 Anatomy - Circulation o
6、f CSF,Brain and Ventricles,The anatomy of ventricles,、 Anatomy - Circulation of CSF,Choroid plexus (vessels),Ventricle,、 Anatomy - Circulation of CSF,、 Anatomy - Circulation of CSF,Circulation in ventricular system,Arachnoid granulation,Superior sagittal sinus,Aqueduct,Choroid plexus,The 4th ventric
7、le,Subarachnoid spaces,、 Anatomy - Circulation of CSF,500ml/d and keep homeostasis,Circulatory system (blood vessels system),、 Anatomy - Intracranial Vessels,Arterial System,Venous System,There are three components in the cranial cavity: brain, blood, and CSF. Brain is the major one, blood vessels s
8、ystem is within the brain, CSF is produced and absorbed by vessel system, and CSF is in the ventricles and subarachnoid spaces.,To sum up,Increased Intracranial Pressure,、 Anatomy 、 Increased Intracranial Pressure 、 Regulation of ICP 、 Pathogenesis 、 Clinical symptoms and signs 、 Diagnosis of Increa
9、sed Intracranial Pressure,Definition of ICP,Intracranial Pressure ( ICP) ICP is the pressure inside the cranial cavity，created by the total volume of the intracranial contents and exerts on cranial wall.,、 Increased Intracranial Pressure,A. Normal value of ICP:,Adults: 0.72.0 kpa (70200mmH2O) Childr
10、en: 0.51.0 kpa (50100mmH2O),(Normal ICP has small fluctuations due to respiration and cardiac pulse.) ICP is influenced by respiratory and circulatory movement.,、 Increased Intracranial Pressure,、 Increased Intracranial Pressure,B. Increased ICP:,ICP 2.0 kpa (200mmH2O),Increased ICP: ICP is persiste
11、ntly higher than 2.0 kPa,Not Temporary A clinical syndrome requiring prompt diagnosis and urgent treatment,C. Measurement of ICP,、 Increased Intracranial Pressure,1. Lumbar Puncture,easy to perform most commonly used in clinic,Pressure in spinal subarachnoid space equals to pressure in cranium,Two d
12、isadvantages: Inaccurate /incorrect when abnormal csf communication Danger of precipitating acute brain herniation,Lumbar Puncture,2. ICP monitoring,、 Increased Intracranial Pressure,C. Measurement of ICP,More Accurate Monitoring continuously,Traumatic Examination Infection hematoma,Pressure monitor
13、ing probe,Increased Intracranial Pressure,、 Anatomy 、 Increased Intracranial Pressure 、 Regulation of ICP 、 Pathogenesis 、 Clinical symptoms and signs 、 Diagnosis of Increased Intracranial Pressure,Regulation of ICP,1. Regulation of ICP by intracranial contents,A change in the volume of the one intr
14、acranial content causes a relative change in the volume of the other contents,ICP rising,spinal subarachnoid space,(1) Regulation of ICP by CSF（10%）,CSF,ICP0.7kPa,The volume of CSF increase,ICP2.0kPa,The volume of CSF decrease,CSF,secretion increase,absorption decrease,CSF,secretion decrease,absorpt
15、ion increase,_,(1) Regulation of ICP by CSF,(2) Cerebral blood compromise little room,Cerebral blood compromise little room to regulate ICP,(3) Brain tissue compromise little room,Brain tissue compromise little room to regulate ICP,Cranial cavity of an adult is fixed,2. Cranial cavity cannot regulat
16、e ICP,Cranial cavity of children can enlarge to fit the increased ICP,The volume of intracranial contents increase 5% of total volume of intracranial contents,ICP rising,The volume of intracranial contents increase 8-10% of total volume of intracranial contents,Severe ICP,Physiological regulation of
17、 ICP is effective but limited CSF exerts the most important role to regulate ICP,To sum up,Increased Intracranial Pressure,、 Anatomy 、 Increased Intracranial Pressure 、 Regulation of ICP 、 Pathogenesis 、 Clinical symptoms and signs 、 Diagnosis of Increased Intracranial Pressure,、 Pathogenesis,Major
18、causes of Increased ICP,A Increased volume of normal intracranial components,B Space occupying lesions,C Congenital malformations,、 Pathogenesis,A. Increased volume of normal intracranial components,. Brain edema,. Hydrocephalus, . Vasodilatation,、 Pathogenesis,Space occupying lesions ( Hematoma, br
19、ain abscess, tumor et,al. ),Brain Specimen with an occupying lesion,Intracranial hematoma,、 Pathogenesis,C. Congenital Malformation ( Constrictive Cranial Cavity , Craniostenosis),Usually occur in children With development ,cranium stop developing Compared with brain, cranium is small,、 Pathogenesis
20、,D. Other diseases,great depressed skull fracture,、 Pathogenesis,Major causes of Increased ICP,Increased Intracranial Pressure,、 Anatomy 、 Increased Intracranial Pressure 、 Regulation of ICP 、 Pathogenesis 、 Clinical symptoms and signs 、 Diagnosis of Increased Intracranial Pressure,、 Clinical sympto
21、ms and signs,Three main clinical manifestations:,1、 Headache 2、 Nausea and Vomiting. 3、 Papilloedema,、 Clinical symptoms and signs,Clinical presentations,1、 Headache,worse on waking in the morning and relieved by vomiting. Pain on the frontal, temporal or occipital part The causes include venous dil
22、atation, traction and compression of the pain-sensitive structure (blood vessels and dura mater),、 Clinical symptoms and signs,Clinical presentations,2、 Nausea and Vomiting.,very popular symptoms, almost happen in every patient with increased ICP. Increased ICP affects the vomiting center of brain s
23、tem,Clinical sign,3、 Papilloedema This is an objective and definitive sign of raised ICP. When ICP increased, the blood in the vessels along the optic nerve will be slowed down and edema of optic disc will happen.,、 Clinical symptoms and signs,normal,papilloedema,Funduscopy,ophthalmofundoscope,、 Cli
24、nic symptoms and signs,Other Clinical manifestations,Disturbance of Consciousness Drowsiness, Coma depressed consciousness indicates neurological deterioration. Diplopia (double vision) it is due to the paralysis of abducent nerves. abducent nerve is compressed easily for its long track,Increased In
25、tracranial Pressure,、 Anatomy 、 Increased Intracranial Pressure 、 Regulation of ICP 、 Pathogenesis 、 Clinical symptoms and signs 、 Diagnosis of Increased Intracranial Pressure,A. clinical history headache and vomiting B. neurological examination papilloedema: definitive sign lumbar puncture or direc
26、t monitoring radiological investigation CT/MRI or cerebral angiography,、 Diagnosis of raised ICP,Cerebral contusion and laceration,Some radiological images of patients with increased ICP,Subdural hematoma (Crescent),Epidural hematoma (Biconvex),Chronic subdural hematoma,Meningioma,Giant meningioma,Glioma,Brain abscess,Cerebral hemorrhage,
