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Surgical Procedures 1 > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

carpal tunnel release: definition (2)

A
  • decompression of median nerve

- achieved by incising transverse carpal ligament

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2
Q

carpal tunnel release: special equipment

A

hand positioning device (lead hand)

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3
Q

what ligament is divided for carpal tunnel release procedure?

A
  • transverse carpal ligament (flexor retinaculum)*

- divided by #15 blade #7 handle

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4
Q

ulnar nerve transposition: definition

A

relocation of ulnar nerve
-relieves symptoms:
ulnar nerve palsy/cubital tunnel syndrome

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5
Q

ulnar nerve transposition: pathophysiology (2)

A
  • ulnar nerve palsy

- cubital tunnel syndrome

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6
Q

ulnar nerve transposition: antibiotic irrigation (2)

A
  • polymyxin

- bacitracin

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7
Q

rhizotomy: definiton

A

surgical interruption of cranial or spinal root nerve to treat intractable pain when less invasive options have failed

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8
Q

rhizotomy: cordotomy

A

surgical division interruption of lateral spinothalmic tracts of spinal cord

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9
Q

rhizotomy: sympathectomy

A

excision of portion of sympathetic division of ANS

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10
Q

rhizotomy: peripheral neurectomy

A

partial or total excision of a peripheral nerve segment

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11
Q

rhizotomy: neurolysis

A

freeing or loosening of nerve from adhesions to restore nerve function or relieve pain

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12
Q

textbook indication for rhizomtomy…

A
  • trigeminal neuralgia*

- aka tic douloureux

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13
Q

magnetic resonance imaging (MRI) are used for..

A

high resolution imaging of soft tissue to detect abnormalities

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14
Q

rhizotomy: positioning (2)

A
  • wilson frame or chest rolls

- jackson table for C-arm access (intra-operative fluoroscopy)

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15
Q

rhizotomy skin preparation: what should be avoided

A
  • methylene blue*

- causes inflammatory reaction in CNS tissue

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16
Q

rhizotomy: vertebral level confirmation is achieved by?

A

placing metal (radiopaque) object suspected level and taking X-ray/fluoroscopy

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17
Q

oh shit neuro suture

A

4-0 silk

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18
Q

rhizotomy: dura mater is incised with

A 
#11 blade
#7 handle
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19
Q

laminectomy: defintion

A
  • means of exposure for other surg. procedures*

- excision of 1 or more laminae to expose spinal canal and adjacent structures

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20
Q

laminectomy: discectomy

A

removal of herniated intervertebral disk

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21
Q

laminectomy: foraminotomy:

A

enlargement of an intervertebral foramen to relieve spinal nerve compression

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22
Q

laminectomy: laminotomy

A

conservative approach to spinal canal w/ limited division of vertebral lamina

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23
Q

lumbar laminectomy: intrathecal pump

A

implantation of medication-delivery device to treat intractable pain or spastic conditions

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24
Q

cervical region of spine

A
  • 7 vertebrae, C1-C7*

- most superior

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25
Q

thoracic region of spine

A
  • 12 vertebrae, T1-T12*

- second most superior

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26
Q

lumbar region of spine

A
  • largest/strongest of unfused vertebrae*
  • 5 vertebrae, L1-5*
  • third most superior
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27
Q

sacral region of spine

A
  • 5 fused vertebrae, S1-S5*

- fourth most superior

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28
Q

5 sets of paraspinal ligaments (3)

A
  • anterior/posterior longitudinal
  • interspinous/suprasinous ligaments
  • ligmentum flavum (yellow ligament)
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29
Q

anatomy of vertebrae

A

tough outer: annulus fibrosis

soft elastic inner: nucleus pulpous

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30
Q

3 membranes of spinal cord deep to superficial

A
  • pia mater (innermost)
  • arachnoid mater (middle layer)
  • dura mater (outermost strongest layer forming fluid tight sack from foramen magnum-S2)
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31
Q

lumbar laminectomy: pathophysiology

A
  • herniated disk*
  • protrusion of uncles pulpous
  • extruded disk fragment compresses adjacent tissue
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32
Q

90% of disk herniations occur…

A
  • L4-L5

- L5-S1

33
Q

lumbar laminectomy: stenosis (3)

A
  • excision of osteophytes relieves symptoms*
  • impingement of neural tissues by bony structures
  • bone spurs (osteophytes)
34
Q

CT scan/X-ray study

A

criterion standard for evaluation of boney abnormalities

35
Q

myelography:

A

antiquated study administration of radiopaque substance into the subarachnoid space of the spinal column, highlighting impingement of neural tissues

36
Q

lumbar laminectomy: positioning

A
  • prone (wilson frame utilized)
  • modified knee to chest (andrew hicks table)
  • lateral (not commonly used)
37
Q

pituitary (forceps) rongeur:

A
  • soft tissue*

* removal of herniated disk fragments*

38
Q

kerrison rongeur:

A
  • small bites of hard tissue*
  • 2mm, 3mm, 5mm*
  • removal of bone
39
Q

leksell rongeur:

A
  • removes spinous process*

* large bites of bone*

40
Q

midas rex drill/triton system/stryker TPS

A
  • grinding away lamina*

- bone

41
Q

penciled dissector

A
  • P4*
  • exploration of foramen
  • assessment of nerve decompression
42
Q

lumbar laminectomy: nerve hook/woodson elevator

A

used to assess nerve root decompression

43
Q

lumbar laminectomy: complications (4)

A
  • SSI
  • hemorrhage
  • paralysis
  • blood clots/primary embolism
44
Q

anterior cervical discectomy and fusion (ACDF): defintion

A

excision of intervertebral disc through anterior approach with stabilization by bone graft

45
Q

anterior cervical discectomy and fusion (ACDF): pathophysiology (3)

A
  • degenerative disc disease
  • radiculopathy (spinal nerve root compression)
  • myelopathy (spinal cord compression)
46
Q

anterior cervical discectomy and fusion (ACDF): positioning (2)

A
  • shoulder roll placed to extend neck and accentuate exposure of operative site
  • PTs head slightly turned away form affected side
47
Q

anterior cervical discectomy and fusion (ACDF): incision

A

transverse skin incision made over confirmed cervical vertebrae level (cricoid cartilage)

48
Q

anterior cervical discectomy and fusion (ACDF): supplies

A
  • 3 1/2 spinal needle*

- intraoperative vertebral level confirmation

49
Q

anterior cervical discectomy and fusion (ACDF): bone graft harvested with?

A

hudson brace (burr holes)

50
Q

craniotomy:

A

temporary removal of section of cranial bone

51
Q

craniectomy:

A

permanent removal of section of cranial bone

52
Q

burrhole: (2)

A
  • small hole made in cranium w/ cranial spinal perforator

- minimum exposure possible to gain brain access

53
Q

cranioplsaty: definition

A

surgical repair of skull to correct traumatic injury or congenital malformation

54
Q

ventriculoperitoneal (VP) shunt placement: definition (2)

A
  • placement of catheter to divert flow of excess CSF from brain to body cavity
  • procedure of choice due to avoidance of vascular/cardiopulmonary complications
55
Q

ventriculoperitoneal (VP) shunt placement: pathophysiology

A
  • hydrocephalus*
  • increase in volume of CSF increasing ICP
  • communicating=external
  • non-communication=internal
56
Q

what is a common indication for pediatric hydrocephalus

A

sunset sign (eyes)

57
Q

ICP measured through cerebral manometry using…

A

manometer

58
Q

transphenoidal hypophysectomy: definiton

A

partial or total excision of pituitary adenoma to treat hyposecretory endocrine disorders

59
Q

is transphenoidal hypophysectomy a sterile procedure?

A 
no
class 2: clean contaminated
60
Q

ventriculoscopy: definition (2)

A
  • examination of ventricles of the brain by lighted neuroendoscope
  • treats PTs w/ non-communicating (internal) hydrocephalus
61
Q

ventriculoscopy: supplies

A

3 french fogarty balloon catheter inserted through 2mm working port and inflated widening ventriculoscopy stoma to 5mm

62
Q

circle of willis receives its blood supplies from… (2)

A
  • anteriorly: two internal carotids

- posteriorly: two vertebral arteries

63
Q

scalp clips (4)

A
  • control scalp bleeding*
  • adson
  • leroy
  • michael
  • raney
64
Q

powered by compressed nitrogen (3)

A
  • craniotome
  • triton
  • anspach
65
Q

powered by electricity

A

stryker drill

66
Q

burr holes are connected by channels cut with…

A

gigli saw/guide

67
Q

dural incisions are extended with…(4)

A
  • potts smith angulated
  • metzenbaum
  • taylor
  • strully
68
Q

two types of pin fixation devices

A
  • gardner wells

- mayfield

69
Q

retractors

A

stable operating field:

  • greenberg
  • budde halo retractor

exposure:
-leyla-yasargil

70
Q

sponges used intracranially

A

-cottonoid patties/balls (soaked in antibiotic solution)

71
Q

absorbable hemostatic agents (4)

A
  • gelfoam
  • surgicel
  • oxycel
  • avitene/helistat
72
Q

most common antibiotic solutions used as irrigants…

A
  • lactated ringers solution

- normal saline

73
Q

dural closure is achieved with…

A

4-0 silk
4-0 braided nylon
4-0 vicryl

74
Q

what is used to increase micturition causing decrease in blood volume

A

mannitol

75
Q

neurosurgical instruments are typically/surgeons like to use

A

bayoneted/microscope

76
Q

aneurysms are isolated with which suture

A

fine silk

77
Q

fusiform aneurysms are handled by

A

wrapping entirety with methacrylate impregnated gauze or muslin

78
Q

arteriovenous malformation (AVM)

A

abnormal communication between arterial and venous systems

79
Q

entire shunt system must be… (2)

A
  • free of lint/glove powered contamination

- soaked in antibiotic/ringers lactate

Surgical Procedures 1 (12 decks)

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