Nervous System( 신경계 )

신경외과 장 경 술

Major Subdivisions:Central Nervous System( 중추신경계 ): CNS

The brain( 뇌 )

The spinal cord.( 척수 )

Autonomic Nervous System: ( 자율신경계 ) :ANS

Sympathetic nervous system( 교감신경 )

Parasympathetic nervous system( 부교감신경 )

The Nervous System

Divisions of the Nervous System

Nervous Tissue( 신경조직 )

• Neurons( 신경세포 ) - transmit impulses– sensory (afferent, ascending)

– motor (efferent, descending)

• Neuroglia( 신경아교세포 ) - support neurons

Neuron

• Dendrites( 가지돌기 )-rootlike structures that receive impulses and conduct them to the cell body

• cell body( 세포체 ) - contains nucleus

• Axon( 축삭 )-extends away from the cell body and conducts impulses away from the nerve cell

Neuron Anatomy

• Myelin sheath( 말이집 )- – insulation– accelerates impulse transmission– appears as white covering

• myelin on axons in brain and spinal cord gives white appearance

• unmyelinated fibers, dendrites, and nerve cell bodies comprise gray matter of brain and spinal cord

Neuron Anatomy(peripheral nerves)

• Schwann cell– type of neuroglial cell

wrapped around axon

– forms the myelin sheath

• Neurolemma (neurolemmal sheath)– permits a damaged axon to

regenerate

– neurolemma NOT found in Central nerves

Neuroglia( 신경아교세포 )

• gli/o or nerve glue• neuroglia or glial cells• Astrocytes( 별아교세포 ) -

blood brain barrier• Oligodendrocytes(

희소돌기아교세포 ) - facilitate myelin development

• Microglia( 미세아교세포 ) - phagocytic properties

• Ependyma( 뇌실막세포 ) - assist in CSF circulation

Neuroanatomy

• The Study of Nervous System– Two Levels

• General Structure( 일반구조 )

• Function of Structure( 기능적 구조 )

뇌 (brain)

• 대뇌 (cerebrum)• 중뇌 (midbrain)• 뇌교 (pons)• 연수 (medulla)• 소뇌 (cerebellum)

Surface

• Gyrus( 회 , 이랑 )– A convolution

• Sulcus( 구 , 고랑 )– A small in-folding (small

groove) • Fissure( 틈새 , 열구 )

– A large in-folding ( a large groove)

Two-thirds of the cortex is hidden in the grooves

Major Structures of the Cortex

• The lobes are distinguished both structurally and functionally

• 4 Lobes– Frontal Lobe( 전두엽 )– Parietal Lobe( 두정엽 )– Occipital Lobe( 후두

엽 )– Temporal Lobe( 측두

엽 )

• Major Fissures– Central Sulcus– Longitudinal Fissure– Sylvian Fissure

Sylvian Fissure

Longitudinal Fissure

Cortical Function

• Frontal Lobe– Higher thought

processing; decision making; abstract thinking

– Primary “precentral” motor area

• Parietal Lobe– Primary “postcentral”

somatosensory area: sensation of muscles, organs, and skin

Cortical Function

• Occipital Lobe– Visual processing

• Temporal Lobe– Auditory &

equilibrium processing– Left temporal lobe

involved in speech and comprehension of language

뇌실질 (brain parenchyme)

• Gray Matter( 회질 ): Neural Cell Bodies( 세포체 )

– Nuclei – Collection of neural cell bodies of similar shape

• White Matter( 백질 ): Axons– Tract - A bundle of axons

Basal Ganglia( 기저핵 ) : 운동기능

Basal Ganglia a collection of subcortical nuclei involved in the control of movement

Basal Ganglia:

3 Major structures Caudate nucleus ( 미상핵 )Globus pallidus(담창구 ) Putamen( 피각부 )

Caudate nucleus PutamenGlobus pallidus

Diencephalon( 간뇌 )

2 Major Structures- Thalamus( 시상 ) 터미널기능- Hypothalamus(시상하부 )

Thalamus- Two lobes that relay sensory projection fiber info to the cerebral cortex

Hypothalamus- Lies at the base of the brain- Controls and regulates the endocrine system (hormones), autonomic system, species survival (the four Fs) and sleeping.- Contains many nuclei and fiber tracts

Diencephalon

• All sensory modalities relay through the thalamus

Thalamus

Surrounds the 4th ventricle

• Mid brain( 중뇌 )• Pons( 뇌교 )• Medulla( 연수 )

Brain Stem: 숨골

Pons( 뇌교 )

• Fiber Tracts & Nuclei important in sleep and arousal

Medulla( 연수 )

– Regulates cardiovascular system, respiration, skeletal muscle tonus

Cerebellum( 소뇌 )

– Two hemispheres– Integrates and

coordinates standing, walking, coordinated movements

cerebellum

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The Brain: A Well-Protected Organ

( 두개골 )

( 두피 )

( 경막 )

The Skull( 두개골 )

• The First Line of Defense

Meninges( 수막 )

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Meninges

• 3 Tough Layers of Connective Sheath

– Dura Mater (outer: 경막 )– Arachnoid Mater

(middle: 지주막 )– Pia Mater (inner: 연막 )

Meninges

• Provide three layers of protection & padding around the brain & spinal cord

• Enclose, protect blood vessels • Contains CSF

임상

• Meningitis ( 뇌수막염 )• Meninigioma( 뇌수막종 )• Epidural hematoma ( 경막외혈종 )• Subdural hematoma ( 경막하혈종 )• Craniotomy ( 두개골절개술 )• Craniectomy ( 두개골절제술 )• Duroplasty ( 경막성형술 )• Cranioplasty( 두개골성혈술 )

The Cerebrospinal Fluid(CSF: 뇌척수액 )

• Liquid cushion for brain and spinal cord; reduces shock of head movements (The brain floats in a bath of CSF)

• Nourishes brain( 영양 )• Removes waste• Filtrate of blood

CSF Circulation

• Produced in Choroid Plexus

– 500 ml/day

Total Volume: 70 – 120 ml

Lateral Ventricles: 측뇌실 largest

Third Ventricle: 3 뇌실“wall” divides brain into symmetrical

halves

Cerebral aqueduct: 도수관long tube that

connects 3rd to 4th ventricle

Fourth Ventricle: 4 뇌실

The Four Ventricles

임상

• Vetriculitis ( 뇌실염 )

• EVD (extra ventricular drainage) 뇌실외배액술 • CSF study( 뇌척수액 검사 )

• V-P shunt( ventriculo-peritoneal shunt: 뇌실복강단락술 _

Spinal Cord( 척수 ): The Peripheral Nervous System

말초신경계Spinal cord sections indicated by the exit point of nerves

Sensory and motor peripheral nerves connect to sensory and motor neurons in the CNS

Major Divisions of the Peripheral Nervous System:The Autonomic Nervous SystemThe Somatic Nervous System

Spinal CordGross Anatomy

Four Major RegionsCervical( 경추 )Thoracic( 흉

추 )Lumbar( 요추 )Sacral( 천추 )

임상

• Vertebra( 척추 )

• Spinal stenosis( 척추협착증• Spondylolisthesis( 척추전방전이증 )

• Spondylolysis( 척추분리증 )

• Spondylitis( 척추염 )

• Laminectomy( 협궁절제술 )

Cerebrovascular Disease

• Arteriosclerosis

• cerebrovascular accident (CVA, apoplexy)– ischemia– transient ischemic attack(TIA)– hemiparesis– hemiplegia– aphasia– ataxia

Oncology

• Intracranial tumors– Astrocytoma ,globlastoma,oligodendroglioma,– Ependymoma, – metastatic sites

• Signs and Symptoms– headaches– papilledema– personality changes

• cerebral palsy

• closed head trauma

• coma

• Concussion

• Huntington’s chorea

• hydrocephalus

• paraplegia

• paresis

• Paresthesia

• poliomyelitis

• quadriplegia

• sciatica

• syncope

• transient ischemic attack (TIA)

• Cerebral angiography

• echoencephalography

• electroencephalography (CCG)

• myelography

• computed tomography (CT scan)

• spinal puncture, spinal tap

• trephination

Pharmacology• Analgesics

• anticonvulsants

• antidepressants

• hyponotics

• opiates

• sedatives

• tranquilizers

Abbreviations

• ALS

• ANS

• CP

• CSF

• CT scan

• CVA

• CVD

Abbreviations

• EEG

• ICP

• LP

• MRI

• MS

• R/O

• TIA