Neurological procedures Lecture Powerpoint

Question 1

Neurosurgery definition

Answer 1

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

Question 2

Purposes for neurosurgery (4)

Answer 2

• Diagnosis via biopsy or puncture
• Evacuation of fluid or abscess
• Excision/decompression
• Repair of damaged structures

Question 3

Burr hole

Answer 3

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

Question 4

Craniotomy

Answer 4

Opening into skull via hole or flap that is retractable

Question 5

Craniectomy

Answer 5

Excision of part of skull

Question 6

Cranioplasty

Answer 6

Plastic surgery of skull, bone or plate replacement

Question 7

ICP monitoring

Answer 7

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.)

Question 8

ICP and normal value

Answer 8

Intracranial pressure, normal levels of 7-15 mmHg supine

Question 9

CPP and normal value

Answer 9

Cerebral perfusion pressure, ability to perfuse brain dependent on mean arterial pressure minus intracranial pressure, should be 50-150 mmHg

Question 10

Ventricular peritoneal shunt (VP shunt)

Answer 10

Functions to divert CSF from the ventricles into the peritoneal space thru subcutaneous tube attachment that is indicated for treatment of hydrocephalus

Question 11

Lumbar peritoneal shunt (LP shunt)

Answer 11

Less common used way to divert CSF from the lumber region to the peritoneal space thru tube placement often for treatment of hydrocephalus

Question 12

Craniotomy/craniectomy indications (5)

Answer 12

• open cerebral aneurysm repair
• massive hemorrhage repair
• resection of brain tumor
• removal of brain abscess
• biopsy of abnormal brain tissue

Question 13

Sterotaxy

Answer 13

Usage of 3d reconstruction and MRI guidance to target lesions such as brain metastases, pituitary adenoma, etc.

Question 14

Neuroendovascular surgery

Answer 14

Less invasive operative treatment of vascular diseases affecting the brain’s blood flow

Question 15

Neuroednovsacular indications (3)

Answer 15

• Acute ischemic stroke
• intracranial atherosclerosis
• cerebral aneurysm repair

Question 16

Vagal nerve stimulator

Answer 16

Device implanted in chest wall programmed to stimulate vagus nerve which may help treat seizure activity

Question 17

Deep brain stimulation

Answer 17

Implantation of electrodes within certain areas that regulate abnormal impulses useful in treatment of many diseases

Question 18

Kyphoplasty

Answer 18

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

Question 19

Laminectomy

Answer 19

More invasive spine process involving removal of the lamina of the spine

Question 20

Laminectomy indications (5), discectomy indications

Answer 20

• spinal stenosis
• sciatica
• herniated disk
• osteoarthritis
• posterior column tumors

-same as laminectomy but all with radiculopathy (pinched nerve)

Question 21

Discectomy

Answer 21

Removal of part of the disk to prevent compression of a spinal nerve

Question 22

Laminectomy, discectomy, and posterior fusion are often all done….

Answer 22

….at the same time

Question 23

Posterior spinal fusion

Answer 23

Involves mechanical screwing using pedicle screws after removing lamina connected by slabs that prevent the movement and any further pain in that joint

Question 24

Posterior spinal fusion indications (3)

Answer 24

• severe degenerative disc dz
• trauma
• iatrogenic destabilization of joint due to multiple disc or laminectomies

Question 25

Anterior cervical discectomy and fusion

Answer 25

Common procedure performed similar to lumbar fusion done easily thru retraction of trachea and esophagus to side

Question 26

Lumbar puncture indications (6)

Answer 26

• Suspected CNS infection
• Idiopathic intracranial hypertension (pseudomotor cerebri)
• normal pressure hydrocephalus
• MS
• Guillan Barre syndrome

Question 27

Lumbar puncture general steps (12)

Answer 27

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

Question 28

Lumbar puncture complications (6)

Answer 28

• 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

Question 29

Most common complication from lumbar puncture

Answer 29

Headache from CSF leak

Question 30

Carpal tunnel and ulnar nerve decompression

Answer 30

• 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