By Andrew H. Kaye
Crucial Neurosurgery offers a entire advent to neurosurgery for junior surgical trainees and clinical scholars. The e-book concentrates at the ideas of neurosurgical analysis and administration of the extra universal crucial worried method difficulties, together with an figuring out of neurology and the pathological foundation of neurological ailment. there's additionally assurance of neurosurgical innovations and postoperative sufferer administration. This re-creation brings the textual content totally modern and comprises a few of the organic and technological advances made within the box of neurosurgery that experience stronger surgical chances and sufferer results.
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With progressive herniation and destruction in the brainstem the pupils change from dilated and fixed to midsize and unreactive. These are invariably irreversible events leading to brainstem death. Clinical symptoms and signs of raised intracranial pressure The common causes of raised intracranial pressure are: • space-occupying lesion — cerebral tumour (and oedema), abscess, intracranial haematoma • hydrocephalus • benign intracranial hypertension. The clinical features will be determined in large part by the underlying cause of the raised pressure.
Intracranial lesions that enhance following contrast administration include: • high-grade cerebral gliomas NEUROSURGICAL INVESTIGATIONS 19 Frontal lobe Corpus callosum Sulci Lateral ventricle Falx cerebri Parietal lobe Occipital lobe Frontal horn of lateral ventricle Septum pellucidum Occipital horn of lateral ventricle Pineal gland Sylvian fissure 3rd ventricle Frontal sinus Chiasmatic cistern Orbital roof Quadrigeminal cistern Fig. 1 Normal intracerebral and cranial structures on CT scan at various levels through the cranium.
Obscurations of vision may occur, particularly on standing or stooping, and the swelling of the optic discs may be so severe as to lead to visual failure and associated secondary optic atrophy. An unusual but well-recognized complication of benign intracranial hypertension is spontaneous CSF rhinorrhoea, usually associated with the empty sella syndrome (Chapter 8). Investigations The CT and/or MRI scan will show no cause for the papilloedema and the ventricles will often be smaller than usual. Digital subtraction cerebral angiography or magnetic resonance venography may be performed to exclude thrombosis of a venous sinus as the cause.