Fellowship - neurosurgery

Question 1

You are asked to provide local anaesthesia for awake craniotomy. Describe the innervation of the scalp, including the landmarks for nerve blockade.

Question 2

Discuss the perioperative management of a previously well patient presenting for transsphenoidal resection of a non-secretory pituitary macroadenoma

Question 3

Discuss the perioperative management of a patient requiring clot retrieval for an acute ischaemic stroke

Question 4

Justify your strategies for managing severely elevated intracranial pressure

Question 5

A 44-year-old male is booked for debulking of a large intracranial tumour. Describe the physiological aims during this case. (50%) Justify your anaesthetic technique to achieve these aims. (50%)

Question 6

Outline the pathophysiological insults that exacerbate a primary brain injury following head trauma and indicate how can they be minimised.

Question 7

“A 25 year old man with a history of blunt trauma to the right side of his head has a fixed and dilated right pupil.He has been intubated and ventilated in the emergency department after an initial Glasgow Coma Score (GCS) of 15 on admission had fallen
to 3.Evaluate the pharmacological and non-pharmacological methods to manipulate this patient’s intracranial pressure?”

Question 8

“A 50-year-old patient presents for urgent craniotomy and decompression of a subdural haematoma. Two days ago he was well, but now has a Glasgow Coma Scale score of 11. He is combative and has pulled out his intravenous line. On inspection there are
no obvious veins for cannulation.a. List the options available for induction and intubation. (30%)b. Describe and justify your preferred approach. (70%)”

Question 9

A patient is scheduled for posterior fossa surgery in the sitting position. (a) Outline the precautions you would take to minimise the risk of venous air embolism. (70%)(b) How would you recognise an air embolism intraoperatively? (30%)

Question 10

A 43 year old female with a Grade 1 subarachnoid haemorrhage is scheduled for coiling of her middle cerebral artery in the radiology suite. Discuss the important issues to consider when providing anaesthesia for this patient.

Question 11

Describe the principles of cerebral protection in a patient with an isolated closed head injury.

Question 12

A 40 yo otherwise healthy male presents following a sub-arachnoid haemorrhage. He is scheduled for clipping of a middle cerebral artery aneurysm. Outline the major issues in providing anaesthesia for this patient and describe how you would address them.

Question 13

Discuss the management of cerebral vasospasm following the coiling of a cerebral aneurysm.

Question 14

Outline the issues involved in the pre-operative assessment of the patient presenting for transphenoidal surgery for acromegaly.

Question 15

Describe the principles of cerebral protection in a patient with an isolated closed head injury.

Question 16

Discuss the perioperative use of nimodpine for a patient undergoing clipping of a cerebral aneurysm.

Question 17

Describe the pathophysiology and diagnosis of diabetes insipidus following head injury.

Question 18

Describe the pathophysiology and diagnosis of diabetes insipidus following head injury.

Question 19

Discuss the methods you would use to reduce cerebral swelling during craniotomy for removal of tumour in an adult

Question 20

A 75 yo man is scheduled for a 2 level posterior spinal fusion under general anaesthesia in the prone position. He suffers from stable angina, for which he takes sublingual glyceryl trinitrate. He also takes oral morphine for his back pain. What hazards will his position for surgery present and how may they be minimised?

Question 21

His peroperative blood pressure is 150/90 and the surgeon requests induced hypotension. Justify the level you would lower the blood pressure to and the method chosen.

Question 22

Half way during the first-level fusion, the electronic anaesthetic machine diagnoses that it has an internal fault and without warning shuts all functions off including gas delivery, ventilation and monitoring. How will you manage this situation?

Question 23

Describe the pathophysiology and diagnosis of diabetes insipidus following head injury.

Question 24

What are the advantages and disadvantages of the use of nitrous oxide in general anaesthesia for intracranial surgery?

Question 25

A previously well 38 yo man presents for urgent clipping of a middle cerebral artery aneurysm. He has photophobia, and a blood pressure of 150/90. Give an account of how you would minimise the risk of arterial hypertension at tracheal intubation. Evaluate the use of nitrous oxide as a component of your general anaesthetic for this man. Outline how you would manage post-operative vasospasm in this patient.