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Neuro > (6) Neurosurgery > Flashcards

(6) Neurosurgery Flashcards

1
Q

What is neurosurgery?

A

Surgery performed on the brain or the spinal cord usually for brain and spine tumours, congenital spine defects and vascular lesions

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2
Q

What is a subarachnoid (SA) haemhorrage?

A

Bleeding into the SA usually from ruptured aneurysm at or near the Circle of Willis

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3
Q

What lies in the SA space?

A

Intracranial vessels that give off small perforating branches to the brain tissue

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4
Q

What happens when there is in intercranial aneurysm rupture?

A

Causes intracerebral bleeding with or without a subarachnoid haemorrhage

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5
Q

What is an aneurysm?

A

Localised blood filled dilation of a blood vessel caused by a disease or weakening of vessel wall

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6
Q

What causes an aneurysm?

A

Stretching and thinning of the artery wall over time

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7
Q

What are the two forms of aneurysms?

A
  • Saccular which is a single bulge on one side
  • Fusiform which is a bulge in the middle of the vessel
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8
Q

What are the common sites for aneurysms?

A
  • 85% vessels from the Circle of Willis
  • 20-25% MCA
  • 35-40% ACA
  • 30% internal carotid
  • 10% posterior circulation
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9
Q

What is the most common type of subarachnoid haemorrhage aneurysm?

A

Berry aneurysm (balloon like structure in vessel)

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10
Q

What are risk factors for SAH?

A
  • Age (most common 40-60)
  • F:M (3:2)
  • Hypertension
  • Family history
  • Smoking
  • Cocaine use
  • Alcohol abuse
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11
Q

What are clinical feature of SAH (7)?

A
  • Severe, unrelenting headache (thunderclap)
  • Vomiting
  • Neck stiffness
  • Seizure
  • Lethargy
  • Limb weakness
  • Associated trauma
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12
Q

What are the symptoms and signs of SAH (9)?

A
  • Headache
  • Transient or prolonged loss consciousness
  • epileptic seizure?
  • +/- nausea & vomiting
  • signs of meningism
  • Focal damage
  • papilloedema
  • Reactive hypertension
  • Pyrexia
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13
Q

How is a SAH investigated?

A
  • CT most common diagnosis
  • MRI not routinely used but helps identify multiple aneurysms
  • Lumbar puncture (CSF)
  • Angiography
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14
Q

How is a cerebral aneurysm treated?

A

Surgical treatment
- direct clipping
- balloon embolisation
- wrapping
May be ventilated similar to TBI

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15
Q

What is a complication of SAH?

A

Cerebral Vasospasm

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16
Q

What is cerebral vasospasm?

A

a delayed narrowing of large arteries at the base of the brain after a SAH

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17
Q

When does a cerebral vasospasm usually occur?

A
  • Typical 3-5 days after haemorrhage
  • Maximal narrowing at 5-14 days
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18
Q

What is the treatment for cerebral vasospasm (6)?

A
  • Triple H Therapy
  • keep blood vessels open by increasing the amount of blood to the brain
  • keeping BP up
  • hydration
  • if untreated can lead to cerebral infarcation
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19
Q

What is Triple H Therapy?

A
  1. Hypertension
    - Increase cardiac output & control BP
  2. Hypervolemia
    - intravenous fluids
  3. Haemodilution
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20
Q

What are other complication associated with SAH?

A
  • Rebleeding
  • Hydrocephalus
  • Hyponatremia
  • Seizures
  • Tentorial herniation
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21
Q

What is rebleeding?

A
  • major problem following aneurysm SAH
  • 28 days, 30% rebleed & 70% of those die
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21
Q

What is hydrocephalus?

A

It is an abnormal build up of fluid in the fluid containing cavities in the brain

22
Q

How does hydrocephalus occur?

A
  • Excessive accumulation of CSF results in widening of spaces in the brain (ventricles)
  • Widening creates potentially harmful pressure on the tissues in brain (increase ICP)
23
Q

When does hydrocephalus occur in patients with SAH?

A
  • Acute occurs within 72 hours in ~20% due to CSF obstruction
  • Further 10% it can develop late
24
Q

What is the management for an aneurysm?

A
  • clipping via craniotomy used to be used
  • coiling new technique
  • has less complications & greater survival
25
Q

What does wrapping involve?

A
  • if the width of the aneurysm neck prevents clipping, the muslin gauze may be wrapped around fundus
  • increased risk of haemorrhage
25
Q

What does coiling involve?

A

insertion of platinum coil into the blood vessels through small incision under X ray guidance

26
Q

What is involved in physiotherapy during the acute phase of SAH?

A
  • check angiogram results
  • untreated aneurysm = FLAT BED REST
  • treated aneurysm = risk developing vasospasm
  • when stable physio treatment dependent on presenting problems
27
Q

What is Arteriovenous Malformation (AVM)?

A
  • leading cause of stroke in young people
  • developmental anomalies in the intracranial vasculature (not neoplastic)
  • “Tangled” blood vessels
  • capillaries are missing meaning arteries directly connected veins
  • most common in MCA
  • usually superficial but can be deep
28
Q

What is the clinical presentation of AVM?

A
  • well-localised headache unilateral & throbbing
  • +/- nausea & vomiting
  • cranial nerve involvement?
  • seizures
  • hemiparesis
  • cognitive, language etc
29
Q

How are AVMs investigated?

A
  • MRI
  • Angiogram
  • CT scan
30
Q

What is the treatment for AVMs?

A
  • Goal to diminish amount of blood flowing to AVM
  • Excision (most effective)
  • Embolization of feeding vessels
  • May use stereotactic frame
  • If not treated AVMs will enlarge
31
Q

What is the stereotactic technique?

A
  • Enables accurate placement cannula or electrode in predetermined target
  • CT & MRI compatible
  • head ring attached to skull and rods inserted
  • rods removed and probe inserted using CT
32
Q

What is a brain tumour?

A
  • Growth from different brain cells such as astrocytes, glial cells, lining of ventricles and meninges
  • Benign or Malignant
  • Secondary metastases
32
Q

When is stereotactic surgery used?

A
  • Lesions in thalamic nuclei for tremor
  • lesions globus pallidus
  • electrical stimulation movement disorders
  • aspiration of cyst
  • biopsy for deep tumours
  • irradiation of small, deep rooted AVMs
33
Q

What are the most common sites of tumours in adults?

A
  • Cerebral 80-85%
  • Cerebellar 15-20 %
34
Q

What are the most common sites of tumours in children?

A
  • Cerebral 40%
  • Cerebellar 60%
35
Q

How are brain tumours classified?

A
  • cell type it originates
  • location it originates
35
Q

What are the pathological classifications of brain tumours?

A
  • Gliomas from glial cells
  • Meningiomas from meninges
  • Haemangioblastoma from blood vessels
  • Neuroma from nerve sheets
  • Pituitary adenoma
36
Q

What are the most common types of brain tumours?

A
  • Glioblastoma Multiformes (GBMs) most primary (12-15%)
  • Meningiomas most common benign
  • 67% brain tumours are gliomas
37
Q

What are the grading of Gliomas?

A

G1 - pilocytic astrocytoma
G2 - diffuse astrocytoma
G3 - Anaplastic astrocytoma
G4 - Glioblastomas

38
Q

What are Glioblastoma Multiforme (GBM) tumours?

A
  • most common and aggressive tumour
  • M:F 3:2
  • frontal, parietal, temporal, and thalamic regions
39
Q

What causes GBM?

A
  • unknown
  • genetic abnormalities found
40
Q

What are the symptoms of GBM?

A
  • Headaches
  • Seizures
  • Changes in mental status
  • Personality changes and memory loss
  • vomiting
  • reduced consciousness
41
Q

How are GBM’s investigated?

A
  • MRI
  • CT scans
42
Q

What is the treatment of GBM?

A
  • Surgery (partial debulking)
  • Radiotherapy
  • Stereotactic irradiation
  • Chemotherapy
43
Q

What are the complications of surgery for GBM?

A
  • infection
  • bleeding
  • oedema
  • damage normal tissue
44
Q

What are the complications of radiography for GBM?

A
  • oedema
  • demyelination
  • radionecrosis
45
Q

What are the complications of chemotherapy for GBM?

A
  • Toxicity
  • bone marrow suppression
46
Q

What is the mortality for high grade gliomas?

A
  • depends on tumour location, progression, and pressure
  • many won’t survive >3 years
47
Q

Where do meningiomas occur?

A

Intracranially at the base of the skull close to venous sinuses

48
Q

What are the complications for brain surgery?

A
  • brain damage (primary or secondary)
  • cerebral oedema
  • CSF leak
  • Thrombosis or haemorrhage
  • DVT
  • Epilepsy
  • Infection
49
Q

What should be done on objective assessment with a patient?

A
  • motor
  • sensory
  • cognitive
  • speech
  • cranial nerves
  • balance and mobility
  • functional activity
50
Q

What is involved in physiotherapy for neurosurgery?

A
  • similar to head injury
  • depends on site and severity
  • MDT approach
  • Family involvement
  • Discharge plan

Neuro (11 decks)

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