Chapter 24: Neurosurgery Flashcards
This instrument emits sound waves that penetrate the brain and bounce back to the machine to generate an image. It is used to locate lesions that lie deep beneath the surface of the cerebrum and evaluate the completeness of tumor resection.
Operative Ultrasound Machine
This device emits a variable ultrasonic energy field that emulsifies abnormal tissue while preserving normal neural tissue. Saline ejected from the tip of the handheld unit liquefies the tissue, which is then aspirated back to the unit. This instrument is used when a moderate to large amount of tissue is to be removed.
Cavitron Ultrasonic Aspirator (CUSA)
This positioning allows exposure of the frontal, parietal, and temporal lobes. A simple donut headrest is used for superficial tumor or clot removal, and a three-pin skull fixation system is needed for procedures that require complete immobilization of the head.
Supine
This positioning is used for exposure of the unilateral temporal lobe, occipital lobe, brain stem, or cerebellum.
Stabilization of the body requires a beanbag or chest rolls, tape, and pillows. The head may be placed onto a headrest
or into a fixation device, depending on the type of procedure.
Lateral or Semilateral
This positioning allows bilateral access to the occipital lobe, brain stem, or cerebellum.
It requires the use of a three-pin skull fixation device attached to a frame that attaches to the side rails of the head end of the operating table.
Sitting position
This positioning is used for bilateral access to the occipital lobe, cerebellum, or brain stem.
Chest rolls support the chest, and pillows are placed under the legs and feet. A Mayfield horseshoe headrest supports the patient’s head. A pin fixation device may also be used.
The Prone position
This procedure involves incising the cranium for access to the brain
Craniotomy
The cranium consists of eight bones; one being the _____ bone which forms the forehead, nasal cavity, and orbital roofs
Frontal bone
The cranium consists of eight bones; two being the _____ bones which form the side of the skull just posterior to the frontal bone, forming a large portion of the sides and roof of the cranium
Parietal Bones
The cranium consists of eight bones; one being the ____ bone which forms the back and large portion of the floor of the cranium.
Occipital
The cranium consists of eight bones; two being the _____ bones which form a small portion of the sides and floor of the cranium
Temporal bones
The cranium consists of eight bones; one being the _____ bone forming portions of the base of the cranium, sides of the skull, and base and sides of the orbits
Sphenoid
The cranium consists of eight bones; one being the _____ bone which forms portions of the roof and walls of the nasal cavity, the floor of the cranium, and the walls of the orbits
Ethmoid bone
Three layers of protective tissue called the cranial ____ cover the brain and spinal cord
List the three layers from outermost to innermost
Meninges
Dura Mater, Arachnoid, and Pia Mater
The Dura Mater is composed of what type of connective tissue?
Tough fibrous connective tissue
The arachnoid middle layer of the meninges is a _____ membrane
Serous
The layer closest to the brain is the pia mater; it contains _____ and _____ to provide nourishment to the neural tissue underneath.
Blood vessels and nerves
The space created between the arachnoid mater and the pia mater is referred to as the __________ space, an area that contains cerebral spinal fluid
Subarachnoid
The ______ represents the largest portion of the human brain.
Its surface is covered with convolutions (gyri), that are separated by shallow depressions (sulci) and deep grooves (fissures) into specific lobes
Cerebrum
The _____ is the second largest structure of the brain and is located posterior to the medulla oblongata and inferior to the
cerebrum’s occipital lobe.
The structure of this structure is similar to that of the cerebrum.
Cerebellum
The ____ ____ connects the brain to the spinal cord and consists of the midbrain, pons, and medulla oblongata
Brain Stem
The _____ __ _____ is a ring of arteries that gives rise to the various branches supplying blood to the brain.
Circle of Willis
The cranial nerves are 12 pair of nerves that, with the exception of the first and second, originate in the brain stem
They are responsible for ____ and ____ functions of the body
Sensory and Motor
An _____ hematoma may result from a fractured skull or blow to the head.
The pressure of blood from this arterial bleeding strips the dura away from the skull, causing more bleeding as the tiny veins from the dura to the skull are torn. There may be a symptomless period as the hematoma enlarges to a size sufficient to compress the cerebrum, resulting in a gradual loss of consciousness that can progress to coma and death without surgical intervention.
Craniotomy is performed to relieve the resultant pressure of the hematoma, as well as to debride the area and control bleeding.
Epidural hematoma
A _____ hematoma occurs in relation to severe head injuries. When veins bridging the cerebral cortex to the venous sinuses are torn or the cortex is lacerated, hemorrhage occurs.
Subdural hematoma
________ ________ (AVMs) are congenital defects causing abnormal communication between arteries and veins that divert blood from surrounding brain tissue.
The surgery involves microsurgical resection of the malformation.
Many AVMs have associated aneurysms, increasing the danger of hemorrhage.
High-resolution MRI confirms the existence of an AVM, but selective cerebral angiography is usually necessary to identity details of the lesion.
Arteriovenous malformations (AVMs)
Tumors are diagnosed with CT and high-resolution MRI.
Cerebral angiography is used to show the ______ of tumors and aids in determining the type of tumor. It is also used for detection of AVMs.
Vascularity
_______ are weak spots in the walls of arteries that over time will balloon out from the arterial wall, causing
them to thin sufficiently.
They can rupture, causing severe bleeding in and around the brain.
Aneurysms
______________ is a premature closure of the cranial sutures of an infant.
These sutures should remain open up to the age of 2 to allow for brain expansion. If the sutures fuse too early, the brain may be damaged because of insufficient space for growth.
Craniosynostosis
Craniosynostosis repair:
The ______ suture is the most commonly affected suture, creating a long
and narrow skull.
Sagittal suture
Craniosynostosis Repair:
________ _______ suture craniosynostosis creates a short, high head.
Bilateral coronal
Craniosynostosis repair:
_______ _______ suture involvement flattens the frontal bone and orbit.
Unilateral coronal
Within the brain are a series of interconnected canals and cavities called _______.
Ventricles
Name the correct “order” of the ventricles in the brain.
• First and second large lateral ventricles
• Third ventricles
• Fourth ventricles
• Foramen of Monroe
• Aqueduct of Sylvius
• Central canal of the spinal cord
First and second ventricles connect to the third ventricles through the foramen of Monroe
The third ventricle connects to the smaller fourth ventricles located in the Brain stem by the aqueduct of Sylvius
The fourth is continuous with the central canal of the spinal cord
A clear, colorless fluid containing small amounts of protein, glucose, lactic acid, urea, and potassium, as well as a relatively large amount of sodium chloride.
Cerebral Spinal Fluid (CSF)
This fluid helps to support and cushion the brain and spinal cord and stabilizes the ionic concentration of the central nervous system.
It also acts to filter the waste products of metabolism and other substances that diffuse into the brain from blood.
Cerebral Spinal Fluid (CSF)
CSF is produced by specialized capillaries called ______ ______. These are located in the lateral, third, and fourth ventricles.
Which ventricles produce the largest amount of CSF?
Choroid plexus; lateral ventricles
Name the correct “pathway” that cerebral spinal fluid flows through from the lateral ventricles to the brain and spinal cord.
• Third ventricles
• Interventricular canal
• Fourth ventricles
• Brain and spinal cord surroundings
• Lateral ventricles
• Aqueduct of Sylvius
• Subarachnoid space
• Central canal of the spinal cord and around the cord’s surface
CSF flows from the lateral ventricles, through the interventricular canal into the third ventricle.
From the third ventricle, CSF flows through the aqueduct of Sylvius into the fourth ventricle, where a small portion enters the subarachnoid space through the fourth ventricular wall.
CSF flows from the fourth ventricle into the central canal of the spinal cord and around the cord’s surface
Eventually surrounding the brain and spinal cord.
The CSF is reabsorbed by fingerlike projections of the arachnoid that project into the dural sinuses called _________ ____.
This reabsorption occurs at approximately the same rate that CSF is formed, allowing for a constant CSF pressure.
Arachnoid villi
What instrument measures intraventricular pressure?
Manometer
This procedure involves incising the cranium for access to the brain
Craniotomy
This procedure is done when weak spots in the walls of arteries balloon out from the arterial wall, causing them to thin. They can rupture and cause severe bleeding in and around the brain.
Craniotomy for Aneurysm Repair
This procedure is performed to repair defects in the skull, resulting from a previous cranial procedure, trauma, or congenital anomaly.
Cranioplasty
This procedure is performed to repair a premature closing of the cranial sutures of an infant which may damage the brain because of insufficient space for growth
Craniosynostosis Repair
This procedure permanently removes a section of the cranium using a burr hole to gain access to underlying structures
Craniectomy for steriotactic procedures
This procedure involves creating a new pathway for CSF due to an obstruction in the interventricular system causing increased cranial pressure due to Hydrocephalus
Ventriculoperitoneal Shunt Placement
This procedure is performed for patients who have enlarged lateral and third ventricles and normal sized fourth ventricles
Ventriculoscopy
The _______ ______ is about the size of a grape and is located at the base of brain within the sella turcica
Pituitary gland
A small bony depression in the sphenoid bone
Sella Turcica
The pituitary gland is connected to the hypothalamus by a stalk called ___ _______.
The infundibulum
The __________ releases neurosecretory substances that stimulate the anterior pituitary gland to release hormones
Hypothalamus
Which gland is considered the master gland?
Pituitary gland
Tumors of the pituitary gland are usually benign, and are often responsible for the overproduction of specific pituitary hormones.
True or False?
True
There are two basic approaches in the surgical treatment of pituitary tumors:
__________ is indicated if the tumor is large and pressing against the optic nerves and is similar to the technique previously described.
Craniotomy
There are two basic approaches in the surgical treatment of pituitary tumors:
____________ __________ is indicated for smaller tumors.
The sella turcica is easily approached through the sphenoid sinus, and complete tumor removal is possible for most tumors.
Transsphenoidal resection
The surgical removal / biopsy of a mass on the pituitary gland executed through the nasal cavity where the pituitary gland lives on the sella turcica
Transsphenoidal Hypophysectomy
For spinal procedures performed in the ______ position, the patient is anesthetized on the transport stretcher and rolled onto either the Wilson or Andrews frame or chest rolls.
Prone
Cervical procedures are still occasionally performed in the _____ position, with the head secured by pin fixation and arms extended onto padded armboards.
If performed in the_____ position, the Mayfield horseshoe headrest may replace the OR tables head section for cervical procedures.
Sitting; prone
Anterior approaches to the spine are performed un the ______ position, and the patient may be turned to the prone position to complete the procedure.
supine
The anterior thoracic spine may be approached via thoracotomy in the _______ position.
Lateral
The vertebral column of a normal adult is comprised of _____ vertebrae and is part of the axial skeleton. These individual bones are separated into ____ regions.
They are, from superior to inferior: (place in order)
• Lumbar
• Cervical
• Coccygeal
• Thoracic
• Sacral
33; 5
Cervical, thoracic, lumbar, sacral, and coccygeal
The vertebral column of a normal adult is comprised of _____ vertebrae and is part of the axial skeleton. These individual bones are separated into ____ regions.
They are, from superior to inferior: (place in order)
• Lumbar
• Cervical
• Coccygeal
• Thoracic
• Sacral
33; 5
Cervical, thoracic, lumbar, sacral, and coccygeal
There are ______ bones in the cervical region.
Seven
The uppermost, or first, cervical vertebra (C1) is the _____ , which supports the skull.
The second cervical vertebra (C2) is the _____, which is fused with the body of the atlas; it is responsible for allowing rotation, flexion, and extension of the head.
Atlas; Axis
The remaining five vertebrae (C3-C7), which are similar to each other in their structure, function in a supportive role of the skeleton.
True or False?
True
There are ____ bones in the thoracic region
(T?-T?).
They are larger and stronger than the cervical vertebrae and are the main support for the _____, as each of the 12 ribs forming the thoracic cage articulates with each of the thoracic vertebrae.
Twelve; T1-T12
Thorax
There are ____ lumbar root vertebrae (L?-L?).
The lumbar vertebrae have two main responsibilities:
• They provide support for a major portion of the weight of the body
• allow for much of the flexibility of the trunk.
Thus, the lumbar vertebrae are very large and have heavy bodies.
Five; L1-L5
The ______ is formed by five individual bones that fuse to form one bone in
adulthood.
These group of vertebrae are considered part of the pelvic girdle.
Sacrum
The _____ consists of four fused vertebrae.
It serves as an important attachment for several hip and pelvic muscles
Coccyx
Label the following diagram:
• Body (centrum)
• vertebral foramen
• Pedicle
• Transverse Processes
• Facets of articulating surfaces
• Lamina
• Spinous process
A. Spinous Process
B. Vertebral Foramen
C. Body (centrum)
D. Facets of the articulating surfaces
E. Lamina
F. Transverse Processes
G. Pedicle
The spinal nerves pass through openings between adjacent vertebrae.
These openings are referred to as the ___________ ________.
intervertebral foramina
Intervertebral discs are located between the vertebrae. The disc itself comprises fibrous connective tissue. Its tough outer layer is termed the _____ ______, and the soft core is called the ______ _______.
annulus fibrosis; nucleus pulposus
Label the following diagram:
• Intervertebral foramen
• Nucleus pulposus
• Annulus Fibrosis
A. Nucleus pulposus
B. Annulus Fibrosis
C. Intervertebral foramen
When ________ form within the spinal canal, the cord may be compressed by the bony structure.
This formation of bony spurs is called spondylosis.
Osteophytes
Lumbar _______: advanced lumbar disc disease
Spondylosis
Lumbar ______: advanced constriction of the spinal canal caused by spondylosis
Stenosis
Lumbar ___________: forward displacement of the upper vertebral body on the lower vertebral body
Spondylolisthesis
What surgical procedure is the surgical removal of extruded fragment of lamina to decompress a nerve root that is impinged?
Lumbar Laminectomy for Discectomy with Spinal Fixation
This procedure is performed for the same reason as an open lumbar laminectomy: decompression of an injured spinal disc.
With the help of standard X-rays, fluoroscopy, and endoscopic instruments, the disc is removed and/ or shrunk with the use of a laser.
Microdecompression Endoscopic Spinal Discectomy
What procedure uses an anterior approach that offers the advantage of a direct approach to the disc space without the removal of the lamina?
After the disc is removed, the disc space is filled with cancellous and cortical bone (fusion), usually from the iliac crest.
Anterior Cervical Discectomy and Fusión (ACDF): Cloward Technique
Which procedure uses a posterior cervical approach used for laminectomy for decompression, intradural tumor removal, cordotomy, discectomy, and fusion?
Posterior Cervical Decompression
A surgical procedure to sever nerve roots in the spinal cord.
The procedure effectively relieves chronic back pain. For spinal joint pain, a facet rhizotomy may provide lasting low back pain relief by disabling the sensory nerve at the facet joint.
Rhizotomy
The nervous system of the human body is divided into two systems: the _____ nervous system (???), and the _______ nervous system (???)
Central; CNS
Peripheral: PNS
The central nervous system (CNS), includes the _____ and ______ _____
The peripheral nervous system (PNS), includes the _____ that link the various parts of the body to the CNS. The PNS includes the _____ nerves that originate from the brain, and the _____ nerves that originate from the spinal cord.
The brain and spinal cord
Nerves; cranial; Spinal
At the elbow, the ____ nerve travels through a tunnel of tissue (the ____ tunnel) that runs under the medial epicondyle of the elbow.
This is commonly referred to as the
“funny bone.”
Ulnar; Cubital
Beyond the elbow, the ulnar nerve travels under muscles in relation to the ulna. As the nerve enters the hand, it travels through another tunnel (______ canal).
Guyon’s
Which procedure is the surgical relocation of the ulnar nerve to relieve compression that causes pain / discomfort?
Ulnar Nerve Transposition
Label the following diagram:
• Ethmoid bone
• Frontal bone
• Sphenoid
• Occipital bone
• Parietal bones
• Temporal bones
- Frontal
- Parietal
- Sphenoid
- Temporal
- Occipital
- Ethmoid
Label the following meninges:
• Arachnoid mater
• Pia mater
• Dura mater
• Skull bone
A. Skull bone
B. Dura mater
C. Arachnoid mater
D. Pia mater
Label the following diagram:
• Cerebrum
• Cerebellum
• Brain stem
A. Brain stem
B. Cerebellum
C. Cerebrum
