Neurosurgery Flashcards
carpal tunnel release: definition (2)
- decompression of median nerve
- achieved by incising transverse carpal ligament
carpal tunnel release: special equipment
hand positioning device (lead hand)
what ligament is divided for carpal tunnel release procedure?
- transverse carpal ligament (flexor retinaculum)*
- divided by #15 blade #7 handle
ulnar nerve transposition: definition
relocation of ulnar nerve
-relieves symptoms:
ulnar nerve palsy/cubital tunnel syndrome
ulnar nerve transposition: pathophysiology (2)
- ulnar nerve palsy
- cubital tunnel syndrome
ulnar nerve transposition: antibiotic irrigation (2)
- polymyxin
- bacitracin
rhizotomy: definiton
surgical interruption of cranial or spinal root nerve to treat intractable pain when less invasive options have failed
rhizotomy: cordotomy
surgical division interruption of lateral spinothalmic tracts of spinal cord
rhizotomy: sympathectomy
excision of portion of sympathetic division of ANS
rhizotomy: peripheral neurectomy
partial or total excision of a peripheral nerve segment
rhizotomy: neurolysis
freeing or loosening of nerve from adhesions to restore nerve function or relieve pain
textbook indication for rhizomtomy…
- trigeminal neuralgia*
- aka tic douloureux
magnetic resonance imaging (MRI) are used for..
high resolution imaging of soft tissue to detect abnormalities
rhizotomy: positioning (2)
- wilson frame or chest rolls
- jackson table for C-arm access (intra-operative fluoroscopy)
rhizotomy skin preparation: what should be avoided
- methylene blue*
- causes inflammatory reaction in CNS tissue
rhizotomy: vertebral level confirmation is achieved by?
placing metal (radiopaque) object suspected level and taking X-ray/fluoroscopy
oh shit neuro suture
4-0 silk
rhizotomy: dura mater is incised with
#11 blade #7 handle
laminectomy: defintion
- means of exposure for other surg. procedures*
- excision of 1 or more laminae to expose spinal canal and adjacent structures
laminectomy: discectomy
removal of herniated intervertebral disk
laminectomy: foraminotomy:
enlargement of an intervertebral foramen to relieve spinal nerve compression
laminectomy: laminotomy
conservative approach to spinal canal w/ limited division of vertebral lamina
lumbar laminectomy: intrathecal pump
implantation of medication-delivery device to treat intractable pain or spastic conditions
cervical region of spine
- 7 vertebrae, C1-C7*
- most superior
thoracic region of spine
- 12 vertebrae, T1-T12*
- second most superior
lumbar region of spine
- largest/strongest of unfused vertebrae*
- 5 vertebrae, L1-5*
- third most superior
sacral region of spine
- 5 fused vertebrae, S1-S5*
- fourth most superior
5 sets of paraspinal ligaments (3)
- anterior/posterior longitudinal
- interspinous/suprasinous ligaments
- ligmentum flavum (yellow ligament)
anatomy of vertebrae
tough outer: annulus fibrosis
soft elastic inner: nucleus pulpous
3 membranes of spinal cord deep to superficial
- pia mater (innermost)
- arachnoid mater (middle layer)
- dura mater (outermost strongest layer forming fluid tight sack from foramen magnum-S2)
lumbar laminectomy: pathophysiology
- herniated disk*
- protrusion of uncles pulpous
- extruded disk fragment compresses adjacent tissue
90% of disk herniations occur…
- L4-L5
- L5-S1
lumbar laminectomy: stenosis (3)
- excision of osteophytes relieves symptoms*
- impingement of neural tissues by bony structures
- bone spurs (osteophytes)
CT scan/X-ray study
criterion standard for evaluation of boney abnormalities
myelography:
antiquated study administration of radiopaque substance into the subarachnoid space of the spinal column, highlighting impingement of neural tissues
lumbar laminectomy: positioning
- prone (wilson frame utilized)
- modified knee to chest (andrew hicks table)
- lateral (not commonly used)
pituitary (forceps) rongeur:
- soft tissue*
* removal of herniated disk fragments*
kerrison rongeur:
- small bites of hard tissue*
- 2mm, 3mm, 5mm*
- removal of bone
leksell rongeur:
- removes spinous process*
* large bites of bone*
midas rex drill/triton system/stryker TPS
- grinding away lamina*
- bone
penciled dissector
- P4*
- exploration of foramen
- assessment of nerve decompression
lumbar laminectomy: nerve hook/woodson elevator
used to assess nerve root decompression
lumbar laminectomy: complications (4)
- SSI
- hemorrhage
- paralysis
- blood clots/primary embolism
anterior cervical discectomy and fusion (ACDF): defintion
excision of intervertebral disc through anterior approach with stabilization by bone graft
anterior cervical discectomy and fusion (ACDF): pathophysiology (3)
- degenerative disc disease
- radiculopathy (spinal nerve root compression)
- myelopathy (spinal cord compression)
anterior cervical discectomy and fusion (ACDF): positioning (2)
- shoulder roll placed to extend neck and accentuate exposure of operative site
- PTs head slightly turned away form affected side
anterior cervical discectomy and fusion (ACDF): incision
transverse skin incision made over confirmed cervical vertebrae level (cricoid cartilage)
anterior cervical discectomy and fusion (ACDF): supplies
- 3 1/2 spinal needle*
- intraoperative vertebral level confirmation
anterior cervical discectomy and fusion (ACDF): bone graft harvested with?
hudson brace (burr holes)
craniotomy:
temporary removal of section of cranial bone
craniectomy:
permanent removal of section of cranial bone
burrhole: (2)
- small hole made in cranium w/ cranial spinal perforator
- minimum exposure possible to gain brain access
cranioplsaty: definition
surgical repair of skull to correct traumatic injury or congenital malformation
ventriculoperitoneal (VP) shunt placement: definition (2)
- placement of catheter to divert flow of excess CSF from brain to body cavity
- procedure of choice due to avoidance of vascular/cardiopulmonary complications
ventriculoperitoneal (VP) shunt placement: pathophysiology
- hydrocephalus*
- increase in volume of CSF increasing ICP
- communicating=external
- non-communication=internal
what is a common indication for pediatric hydrocephalus
sunset sign (eyes)
ICP measured through cerebral manometry using…
manometer
transphenoidal hypophysectomy: definiton
partial or total excision of pituitary adenoma to treat hyposecretory endocrine disorders
is transphenoidal hypophysectomy a sterile procedure?
no class 2: clean contaminated
ventriculoscopy: definition (2)
- examination of ventricles of the brain by lighted neuroendoscope
- treats PTs w/ non-communicating (internal) hydrocephalus
ventriculoscopy: supplies
3 french fogarty balloon catheter inserted through 2mm working port and inflated widening ventriculoscopy stoma to 5mm
circle of willis receives its blood supplies from… (2)
- anteriorly: two internal carotids
- posteriorly: two vertebral arteries
scalp clips (4)
- control scalp bleeding*
- adson
- leroy
- michael
- raney
powered by compressed nitrogen (3)
- craniotome
- triton
- anspach
powered by electricity
stryker drill
burr holes are connected by channels cut with…
gigli saw/guide
dural incisions are extended with…(4)
- potts smith angulated
- metzenbaum
- taylor
- strully
two types of pin fixation devices
- gardner wells
- mayfield
retractors
stable operating field:
- greenberg
- budde halo retractor
exposure:
-leyla-yasargil
sponges used intracranially
-cottonoid patties/balls (soaked in antibiotic solution)
absorbable hemostatic agents (4)
- gelfoam
- surgicel
- oxycel
- avitene/helistat
most common antibiotic solutions used as irrigants…
- lactated ringers solution
- normal saline
dural closure is achieved with…
4-0 silk
4-0 braided nylon
4-0 vicryl
what is used to increase micturition causing decrease in blood volume
mannitol
neurosurgical instruments are typically/surgeons like to use
bayoneted/microscope
aneurysms are isolated with which suture
fine silk
fusiform aneurysms are handled by
wrapping entirety with methacrylate impregnated gauze or muslin
arteriovenous malformation (AVM)
abnormal communication between arterial and venous systems
entire shunt system must be… (2)
- free of lint/glove powered contamination
- soaked in antibiotic/ringers lactate
