Neurological procedures Lecture Powerpoint Flashcards
Neurosurgery definition
To provide care for patients in treatment of pain or pathological processes that may modify the function or activity of the CNS or PNS or ANS, supporting structures, or vascular supply
Purposes for neurosurgery (4)
- Diagnosis via biopsy or puncture
- Evacuation of fluid or abscess
- Excision/decompression
- Repair of damaged structures
Burr hole
Drilling of 2 holes to the level of depth needed to reach a lesion/clot/etc. and then one is used to irrigate with fluid and the other evacuates with a suction
Craniotomy
Opening into skull via hole or flap that is retractable
Craniectomy
Excision of part of skull
Cranioplasty
Plastic surgery of skull, bone or plate replacement
ICP monitoring
Measuring of intracranial pressure of the patient thru a small incision and placement of monitor thru the skull into the tissue of the cerebrum out into the ventricles (but measuring cerebral pressure not ventricular pressure, but this will allow for drainage of CSF in patients with swelling due to lesions, hydrocephalus, etc.)
ICP and normal value
Intracranial pressure, normal levels of 7-15 mmHg supine
CPP and normal value
Cerebral perfusion pressure, ability to perfuse brain dependent on mean arterial pressure minus intracranial pressure, should be 50-150 mmHg
Ventricular peritoneal shunt (VP shunt)
Functions to divert CSF from the ventricles into the peritoneal space thru subcutaneous tube attachment that is indicated for treatment of hydrocephalus
Lumbar peritoneal shunt (LP shunt)
Less common used way to divert CSF from the lumber region to the peritoneal space thru tube placement often for treatment of hydrocephalus
Craniotomy/craniectomy indications (5)
- open cerebral aneurysm repair
- massive hemorrhage repair
- resection of brain tumor
- removal of brain abscess
- biopsy of abnormal brain tissue
Sterotaxy
Usage of 3d reconstruction and MRI guidance to target lesions such as brain metastases, pituitary adenoma, etc.
Neuroendovascular surgery
Less invasive operative treatment of vascular diseases affecting the brain’s blood flow
Neuroednovsacular indications (3)
- Acute ischemic stroke
- intracranial atherosclerosis
- cerebral aneurysm repair
Vagal nerve stimulator
Device implanted in chest wall programmed to stimulate vagus nerve which may help treat seizure activity
Deep brain stimulation
Implantation of electrodes within certain areas that regulate abnormal impulses useful in treatment of many diseases
Kyphoplasty
Minimally invasive surgical filling of an injured or collapsed vertebral body to treat compression fractures due to osteoperosis, myeloma, metastasis, and vertebral angioma but have to have NO neurological symptoms
Laminectomy
More invasive spine process involving removal of the lamina of the spine
Laminectomy indications (5), discectomy indications
- spinal stenosis
- sciatica
- herniated disk
- osteoarthritis
- posterior column tumors
-same as laminectomy but all with radiculopathy (pinched nerve)
Discectomy
Removal of part of the disk to prevent compression of a spinal nerve
Laminectomy, discectomy, and posterior fusion are often all done….
….at the same time
Posterior spinal fusion
Involves mechanical screwing using pedicle screws after removing lamina connected by slabs that prevent the movement and any further pain in that joint
Posterior spinal fusion indications (3)
- severe degenerative disc dz
- trauma
- iatrogenic destabilization of joint due to multiple disc or laminectomies
Anterior cervical discectomy and fusion
Common procedure performed similar to lumbar fusion done easily thru retraction of trachea and esophagus to side
Lumbar puncture indications (6)
- Suspected CNS infection
- Idiopathic intracranial hypertension (pseudomotor cerebri)
- normal pressure hydrocephalus
- MS
- Guillan Barre syndrome
Lumbar puncture general steps (12)
1) verify no contraindications exist by getting good history or physical (high intracranial pressure is NOT a contraindication as long as know what it is caused by)
2) use anticoagulants to prevent increased risk of developing epidural hematoma
3) evidence of cellulitis or abscess (don’t want to introduce into subarachnoid space)
4) drape and prep patient
5) position patient in lateral decubitus/fetal position or sitting upright and leaning over small table
6) locate L3/L4 space by locating superior iliac crests and placing thumbs midline to spine
7) mark location, inject local anasthetic
8) insert spinal needle cephalad angle with bevel oriented to longitudinal fibers to separate instead of cutting them
9) entry into subarachnoid space is a pop, CSF from obturator will drip out
10) check laying down CSF pressure with sterile manometer
11) reinsert obturator and withdraw needle to ensure no other tissue is removed
12) bandage up and apply pressure
Lumbar puncture complications (6)
- herniation of brainstem
- accidental puncture of retroperitoneal vessels, aorta, or vena cava
- accidental puncture of spinal cord
- introduce infection
- pain over LP site
- headache from CSF leak after*** most common complication
Most common complication from lumbar puncture
Headache from CSF leak
Carpal tunnel and ulnar nerve decompression
- Cutting of the transverse carpal ligament to release pressure on median nerve
- Roof of cubital tunnel and sometimes transposition of nerve to relieve pressure on the ulnar nerve
