Functional Neurosurgery and Stereotactic Neurosurgery

Question 1

What is the desirable level of platelets for stereotactic brain biopsy?
● A. ≥ 10,000/mL
● B. ≥ 30,000/mL
● C. ≥ 50,000/mL
● D. ≥ 1,00,000/mL
● E. ≥ 1,50,000/mL

Answer 1

D. ≥ 100,000/mL

Question 2

Which of following is not included in indications of deep brain stimulation?
● A. Movement disorders
● B. Obesity
● C. Hypotension
● D. Epilepsy
● E. Drug addiction

Answer 2

C. Hypotension

Question 3

If tremor is predominant symptom of Parkinson’s disease, then what should be the target of stimulation?
● A. Ventralis intermedius nucleus of the thalamus
● B. Pedunculopontine nucleus
● C. Subthalamic nucleus
● D. Anterior limb of internal capsule
● E. Globus pallidus

Answer 3

A. Ventralis intermedius nucleus of the thalamus

Question 4

Immediately after DBS, anti-Parkinson drugs are continued without any change in dosage for how long?
● A. 1 month
● B. 2 months
● C. 3 months
● D. 4 months
● E. 5 months

Answer 4

B. 2 months

Question 5

In the treatment of dystonia, pallidal stimulation has best results for which of the following types of dystonia?
● A. Postanoxic dystonia
● B. Postencephalitic dystonia
● C. Primary dystonia
● D. Perinatal dystonia
● E. Poststroke dystonias

Answer 5

C. Primary dystonia

Question 6

Local injection of botulinum toxin works for which of the following types of torticollis?
● A. Retrocollis
● B. Anterocollis
● C. Lateral collis
● D. Extrapyramidal torticollis
● E. Horizontal type

Answer 6

A. Retrocollis

Question 7

A patient had H/O spinal trauma 3 months ago. Now the patient has increased tone in limbs but could move limbs passively with ease. According to Ashworth score of spasticity grading, what would be the grade?
● A. 1
● B. 2
● C. 3
● D. 4
● E. 5

Answer 7

C. 3

Question 8

What are the selection criteria for baclofen pump?
● A. Age < 18 years
● B. Not able to give informed consent
● C. Moderate new-onset spasticity
● D. Spasticity responsive to oral baclofen
● E. No CSF block

Answer 8

E. No CSF block

Question 9

What is the maximum dose of dantrolene recommended for spasticity?
● A. 25 mg/d
● B. 25 mg BID
● C. 50 mg BID
● D. 100 mg TID
● E. 100 mg QID

Answer 9

E. 100 mg QID

Question 10

Which of the following is not an ideal candidate for dorsal rhizotomy?
● A. Most often used in children > 2 years of age
● B. Some surgeons reserve SDR for patients who have failed IT baclofen
● C. Mild-to-moderate LE weakness with the ability to walk or maintain antigravity posture
● D. Spasticity hampers gait and/or development of motor skills
● E. Arms worse than legs

Answer 10

E. Arms worse than legs

Question 11

What is the only movement disorder which persists in sleep?
● A. Tourette’s syndrome
● B. Parkinson’s tremors
● C. Palatal myoclonus
● D. Essential tremors
● E. None of the above

Answer 11

C. Palatal myoclonus

Question 12

In trigeminal neuralgia, if immediate relief of pain is required, which procedure should not be used due to its latency?
● A. Radiofrequency rhizotomy
● B. Stereotactic radiosurgery
● C. Balloon compression
● D. Glycerol injection
● E. MVD

Answer 12

B. Stereotactic radiosurgery

Question 13

Once stimulation is achieved during RFR, how should lesioning be done?
● A. 30 to 40C × 90 sec
● B. 60 to 70C × 90 sec
● C. 70 to 80C × 90 sec
● D. 80 to 90C × 90 sec
● E. 20 to 30C × 90 sec

Answer 13

B. 60 to 70C × 90 sec

Question 14

Functional neurosurgery (FN) involves the use of electrical stimulation, ablative therapy, or therapeutic infusions to mask or relieve symptoms of aberrant neurophysiology. FN may be used in the treatment of which of the following?
● A. Movement disorders
● B. Microvascular compression syndromes
● C. Autonomic dysfunction or psychiatric disease
● D. Pain or epilepsy
● E. All of the above

Answer 14

E. All of the above

Question 15

Following are the indications of stereotactic surgery except?
● A. Biopsy for deeply located cerebral lesions or brain stem lesions or for multiple lesions
● B. Catheter placement for drainage of deep lesions or for indwelling catheter placement for intratumoral chemotherapy
● C. Electrode placement for epilepsy or for deep brain stimulation
● D. Lesion generation for movement disorder or for treatment of chronic pain
● E. It cannot be used for evacuation of intracerebral hemorrhage
● F. Stereotactic radiosurgery or for localization of lesion for open craniotomy

Answer 15

E. It cannot be used for evacuation of intracerebral hemorrhage

Question 16

What is the most frequent complication of stereotactic radiosurgery?
● A. Seizure
● B. Hemorrhage
● C. Headache
● D. Memory impairment
● E. Hearing impairment

Answer 16

B. Hemorrhage

Question 17

Deep brain stimulation (DBS) is the use of electrical stimulation through surgically implanted electrodes to produce neuromodulation of electrical signals for the purpose of symptom improvement. The conditions that may be treated using DBS include which of the following?
● A. Movement disorders like parkinsonism or dystonia
● B. Epilepsy
● C. Pain
● D. Potential uses include psychiatric disorders, obesity, or drug addiction
● E. All of the above

Answer 17

E. All of the above

Question 18

An early treatment for Parkinson’s disease was ligation of anterior choroidal artery. Pallidotomy of which area of thalamus is most effective in diminishing tremors?
● A. Anterolateral thalamus
● B. Ventrolateral thalamus
● C. Anterodorsal thalamus
● D. Anteromedial thalamus
● E. Mediolateral thalamus

Answer 18

B. Ventrolateral thalamus

Question 19

Anterodorsal pallidotomy became an accepted procedure in the long-term improvement of rigidity while tremors and bradykinesia did not improve with it. What are the other areas that can be targeted in the treatment of Parkinson’s disease?
● A. Globus pallidus pars interna
● B. Ventral intermediate nucleus of thalamus
● C. Ventrolateral thalamus
● D. Ventralis intermediate nucleus of thalamus
● E. All of the above

Answer 19

E. All of the above

Question 20

Following are the indications for surgical treatment of Parkinson disease except?
● A. Patients refractory to medical treatment
● B. Patients with significant dementia
● C. Primary indication is patients with levodopa-induced dyskinesias
● D. Gait and postural instability
● E. Patients primarily with rigidity and bradykinesia (unilateral or bilateral), on-off fluctuations, or dystonia

Answer 20

B. Patients with significant dementia

Question 21

Which of the following are the contraindications of surgical treatment of Parkinson’s disease?
● A. Patients with significant dementia
● B. Patients at risk of intracerebral hemorrhage
● C. Patients with ipsilateral hemianopsia
● D. Age more than or equal to 85 years
● E. Patients with secondary parkinsonism
● F. Patients with normal dopamine transport scan which may rule out PD as the cause of tremors
● G. All of the above

Answer 21

G. All of the above

Question 22

Significant improvement of levodopa-induced dyskinesias occurred in 90% cases after surgical treatment for Parkinson’s disease, rigidity improved in 75% cases while tremors improved in 57% of cases. What is the percentage of improvement
of bradykinesia after surgical treatment?
● A. 70%
● B. 85%
● C. 95%
● D. 60%
● E. 40%

Answer 22

B. 85%

Question 23

Which of the following steps are included in the deep brain stimulation technique?
● A. Medications (antitremors or antiparkinsonism) are withheld the morning of the procedure to bring out symptoms
● B. A stereotactic frame is applied under local anesthetic parallel to orbitomeatal line
● C. Radiologic target localization is done using MRI or CT of brain
● D. Awake or asleep placement of DBS electrodes is done
● E. All of the above

Answer 23

E. All of the above