外科学教学课件：NEUROSURGERY

1、Welcome to Neurosurgical Course!NEUROSURGERYBrain surgery of Ancient timeDepartment of Neurosurgery, The First Affiliated Hospital of Chongqing University of Medical Sciences Operation Room of NeurosurgeryIncreased Intracranial Pressure(Increased ICP, Raised ICP, Intracranial Hypertension)Neurosurge

2、ry department WANG Xiaoshu Increased Intracranial Pressure、 Anatomy 、 Regulation of ICP、 Increased Intracranial Pressure、 Pathogenesis、 Clinical Symptoms and Signs、 Diagnosis of Increased Intracranial Pressure、 Effects of Increased Intracranial Pressure、 Treatment、 Brain herniation Anatomy- The cran

3、ial cavity The cranial cavity: closed container / poorly distensible Foramen magnumThree intracranial contents ( incompressible )cerebral blood(2-10%、75ml)CSF(8-10%、75ml)brain tissue(80%、1400ml)Anatomy- The cranial cavityAnatomy - Circulation of CSFCirculation in ventricular systemArachnoid granulat

4、ionSuperior sagittal sinusAqueductChoroid plexus(vessels)The 4th ventricleSubarachnoid spaces、 Anatomy - Circulation of CSF500ml/d and keep homeostasisThere are three contents in the cranial cavity: brain tissue , cerebral blood, and CSF. Brain is the major one, blood vessels system is within the br

5、ain, CSF is produced and absorbed by vessel system, and CSF is in the ventricles and subarachnoid spaces. Increased Intracranial Pressure、 Anatomy 、 Regulation of ICP、 Increased Intracranial Pressure、 Pathogenesis、 Clinical Symptoms and Signs、 Diagnosis of Increased Intracranial Pressure、 Effects of

6、 Increased Intracranial Pressure、 Treatment、 Brain herniation Definition of ICPIntracranial Pressure ( ICP) ICP is the pressure inside the cranial cavity，created by the total volume of the intracranial contents and exerts on cranial wall. Normal value of ICP:Adults: 0.72.0 kpa (70200mmH2O)Children:

7、0.51.0 kpa (50100mmH2O)Normal ICP has small fluctuations due to respiration and cardiac pulse.Can keep homeostasis(stable state)Regulation of ICP1. Regulation of ICP by intracranial contentsBrainBloodCSFICP A change in the volume of the one intracranial content causes a relative change in the volume

8、 of the other contents ICP rising spinal subarachnoid space (1) Regulation of ICP by CSFCSFICP0.7kPaThe volume of CSFdecreaseCSFsecretion increaseabsorption decreaseCSFsecretion decreaseabsorption increase_(1) Regulation of ICP by CSF(2) Cerebral blood compromise little roomCerebral blood compromise

9、 little room to regulate ICP(3) Brain tissue compromise little roomBrain tissue compromise little room to regulate ICPCranial cavity of an adult is fixed2. Cranial cavity cannot regulate ICPCranial cavity of children can enlarge to fit the increased ICPThe volume of intracranial contents increase 5%

10、 of total volume of intracranial contentsICP rising The volume of intracranial contents increase 8-10% of total volume of intracranial contentsIncreased Intracranial PressurePhysiological regulation of ICP is effective and limited Increased Intracranial Pressure、 Anatomy 、 Regulation of ICP、 Increas

11、ed Intracranial Pressure、 Pathogenesis、 Clinical Symptoms and Signs、 Diagnosis of Increased Intracranial Pressure、 Effects of Increased Intracranial Pressure、 Treatment、 Brain herniation Increased ICPICP 2.0 kpa (200mmH2O)Sustained ICP greater than 2.0 kPa is termed increased intracranial pressureNo

12、t temporaryA clinical syndromeRequiring prompt diagnosis and urgent treatment Measurement of ICP、 Increased Intracranial Pressure1. Side Lying Lumbar Puncture Easy to perform Most commonly used in clinic2. Direct ICP monitoring、 Increased Intracranial Pressure Measurement of ICP More Accurate Monito

13、ring continuously Traumatic Examination Infection HematomaPressure monitoring probeEpidural monitoringVentricle monitoring (gold standard)Brain tissue monitoringDirect Monitoring of ICPMeasurement of ICPLateral ventricular puncture includesAnterior horn puncturePosteriorhorn punctureMeasurement of I

14、CPIncreased Intracranial Pressure、 Anatomy 、 Regulation of ICP、 Increased Intracranial Pressure、 Pathogenesis、 Clinical Symptoms and Signs、 Diagnosis of Increased Intracranial Pressure、 Effects of Increased Intracranial Pressure、 Treatment、 Brain herniation PathogenesisMajor causes of Increased ICPI

15、ncreased volume of normal intracranial contents Space occupying lesionsCongenital malformations PathogenesisA. Increased volume of normal intracranial contents. Brain edema. Hydrocephalus . VasodilatationPathogenesisSpace occupying lesions( Hematoma, brain abscess, brain tumor, et al. )Intracranial

16、hematomaBrain Specimen with an occupying lesion PathogenesisC. Congenital Malformation(Craniostenosis, Constrictive Cranial Cavity) Occur in children Cranium stop developing early Compared with brain, Cranial cavity is small、 PathogenesisD. Other diseasesLarge depressed skull fracture PathogenesisMa

17、jor causes of Increased ICPIncreased Intracranial Pressure、 Anatomy 、 Regulation of ICP、 Increased Intracranial Pressure、 Pathogenesis、 Clinical Symptoms and Signs、 Diagnosis of Increased Intracranial Pressure、 Effects of Increased Intracranial Pressure、 Treatment、 Brain herniation Clinical symptoms

18、 and signsThree main clinical manifestations:1、 Headache2、 Nausea and Vomiting3、 Papilloedema Clinical symptoms and signsClinical symptoms1、 Headache Worse on waking in the morning and relieved by vomiting. The causes include venous dilatation, traction and compression of the pain-sensitive structur

19、e (blood vessels and dura mater)Clinical symptoms and signsClinical symptoms2、 Nausea and Vomiting Very popular symptoms, almost happen in every patient with increased ICP. Increased ICP affects the vomiting center of brain stemClinical sign 3、PapilloedemaThis is an objective and definitive sign of

20、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 signsnormalFunduscopy use funduscope PapilloedemaIncreased Intracranial Pressure、 Anatomy 、 Regulation of ICP、 Increased Intracranial Pressure、 Pathogenesis、 C