腰穿與腦室外引流

LumbarPuncture12021/4/26CirculationofCerebrospinalFluidIthasbeencalculatedthat430to450mlofCSFareproducedeveryday,sothefluidmustbechangesevery6to7hours.lateralventricles-->

foramenofMonrothirdventricle

-->aqueductofSylvius

-->

fourthventricle

-->

foraminaofMagendieandLuschka

-->

subarachnoidspaceoverbrainandspinalcord

-->reabsorptionintovenoussinusbloodviaarachnoidgranulations.22021/4/26LumbarpunctureMedicalUsesDiagnosticTherapeuticInfectiousdiseasesInflammatorydiseasesNeoplasticdiseases

SubarachnoidhemorrhageHydrocephalusBenignintracranialhypertensionRoutineforyounginfantswithfeverwithoutasource

SubarachnoidorventriclehemorrhageSpinalanesthesia

Chemotherapy32021/4/26LumbarpunctureContraindicationsIdiopathic(unidentifiedcause)

increasedintracranialpressure

(ICP)Rationale:lumbarpunctureinthepresenceofincreasedICPmaycause

herniationException:therapeuticuseoflumbarpuncturetoreduceICP,butonlyifobstruction(forexampleinthethirdventricleofthebrain)hasbeenruledoutPrecautionCTbrain,especiallyinthefollowingsituationsAge>65Reduced

GCSRecenthistoryofseizureFocalneurologicalsignsAbnormalrespiratorypatternHypertensionwithdeterioratingconsciousnessBleedingdiathesis

(relative)CoagulopathyDecreased

platelet

count(<50x109/L)InfectionsSkininfectionatpuncturesiteVertebraldeformities(scoliosis),inhandsofaninexperiencedphysician.42021/4/26LumbarpunctureAdverseeffectsPostspinalheadache

with

nausea

ParesthesiainalegduringtheprocedureSeriouscomplicationsCommoncomplicationsEpiduralbleedingAdhesive

arachnoiditisTraumatothe

spinalcord

or

spinalnerve

roots

Catastrophicepiduralhemorrhagewithabnormalduralarterio-venousmalformations52021/4/26Techniqueandprocedure62021/4/26Techniqueandprocedure72021/4/26EVD(Externalventriculardrainage)ThetwomainreasonsEVDsareinsertedare:1)TodivertinfectedCSFawayfromthebrainandallowantibioticstobegivendirectlyintotheCSFtoremoveinfection.2)ToreducethepressureinsidethebraincausedbyabuildupofCSFduetoablockageorabnormalflowofCSFwithinthebrain.82021/4/26Indications Obstructivehydrocephalus(communicatingandnon-communicating)

Subarachnoidhemorrhage(SAH)resultinginacutehydrocephalusCerebraledema

SurgicalmasslesionsInfectionsChiarimalformationsShuntmalfunctionsduetomechanicaldisruptionorinfectionCerebralspinalfluidleak92021/4/26102021/4/269、人的價值，在招收誘惑的一瞬間被決定。2月-232月-23Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。16:50:5316:50:5316:502/3/20234:50:53PM11、人總是珍惜為得到。2月-2316:50:5316:50Feb-2303-Feb-2312、人亂于心，不寬余請。16:50:5316:50:5316:50Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2月-232月-2316:50:5316:50:53February3,202314、抱最大的希望，作最大的努力。03二月20234:50:53下午16:50:532月-2315、一個人炫耀什么，說明他內(nèi)心缺少什么。。二月234:50下午2月-2316:50February3,202316、業(yè)余生活要有意義，不要越軌。2023/2/316:50:5316:50:5303February202317、一個人即使已登上頂峰，也仍要自強不息。4:50:53下午4:50下午16:50:532月-239、人的價值，在招收誘惑的一瞬間被決定。2月-232月-23Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。16:50:5316:50:5316:502/3/20234:50:53PM11、人總是珍惜為得到。2月-2316:50:5316:50Feb-2303-Feb-2312、人亂于心，不寬余請。16:50:5316:50:5316:50Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2月-232月-2316:50:5316:50:53February3,202314、抱最大的希望，作最大的努力。03二月20234:50:53下午16:50:532月-2315、一個人炫耀什么，說明他內(nèi)心缺