Neurosurgery (1-5)

Question 1

The enlargement of a pupil with or without involvement of other third nerve functions should be taken as diagnostic of a _____ until proven otherwise.

Answer 1

PComm Aneurysm

Question 2

If a PComm aneurysm does not present with pupillary dilation and/or third nerve deficits what may this tell you about location on an angiogram?

Answer 2

Most PComm aneurysms will either point downward or posterolateral but if this were the case it may be stemming more laterally.

Question 3

How would a PComm aneurysm projecting laterally change operative planning?

Answer 3

Early retraction of the temporal lobe may cause premature rupture in this case so care must be taken not to do that

Question 4

Describe Hunt-Hess grading of SAH

Answer 4

Grade I: Awake, mild headache +/- nuchal rigidity
Grade II: Awake, moderate to severe headache and nuchal rigidity
Grade III: Drowsy or confused, +/- focal neurologic deficits
Grade IV: Stuporous, mild to moderate hemiparesis, and signs of raised ICP
Grade V: Comatose, severe disability, and severely increased ICP

Question 5

Which vessel is it important to identify prior to clipping of a PComm aneurysm so it isn’t included in the clip construct? What deficits may occur if it’s included?

Answer 5

Anterior choroidal artery

Contralteral hemiparesis, homonymous hemianopsia, and numbness

Question 6

Where should an incision be made relative to the tragus to avoid damaging the frontal branch of the facial nerve?

Answer 6

1 cm or less from tragus and at the level of the zygomatic arch
(The nerve branches 2.4cm anterior to the tragus and 1.1 cm inferior to zygomatic arch)

Question 7

Where does the frontal branch of the facial nerve course superior to the zygomatic arch?

Answer 7

Courses in the subgaleal space at the same plane as the subgaleal fat pad; care needs to be made when dissecting near subgaleal fat pad to avoid injuring it