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Neurosurgery Flashcards

1
Q

2 structural divisions of nervous system

A

CNS: brain/spinal cord

PNS: sensory/motor neurons

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2
Q

2 functional divisions of nervous system

A

somatic/voluntary: sensory and motor

autonomic: involuntary, viscera + smooth muscle

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3
Q

2 divisions of autonomic nervous system

A

sympathetic: fight or flight
parasympathetic: calming

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4
Q

8 bones of cranium

A

2 parietal

2 temporal

frontal

occipital

sphenoid

ethmoid

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5
Q

foramen magnum

A

opening in occipital bone where spinal cord passes through

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6
Q

3 cranial fossae

A

anterior: circle of willis
middle: temporal lobes, pituitary, inner + middle ear structures
posterior: occipital lobes, cerebellum, brainstem

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7
Q

3 meningeal membranes

A

dura: superficial, tough, white
arachnoid: middle, thin, avascular
pia: inner, transparent, adhered to surface of cord and brain

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8
Q

subarachnoid space

A

CSF between arachnoid and pia maters

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9
Q

principal lobes of cerebrum

A

frontal

parietal

temporal

occipital

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10
Q

3 structures of brainstem

A

midbrain

pons

medulla oblongata

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11
Q

ventricular flow

A

lateral –> monroe –> 3rd ventricles –> cerebral aqueduct –> 4th ventricle –> lushka, magendie –> basal cisterns (arachnoid villi)

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12
Q

where is CSF formed

A

choroid plexus (ependymal cells)

most in lateral ventricles

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13
Q

where is CSF absorbed

A

arachnoid villi in dural venous sinuses

into venous circulation

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14
Q

CSF volume in an adult

A

80-150ml

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15
Q

CSF pressure

A

10-20mmHg

70-200 mmH2O

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16
Q

vertebrae in spinal column

A

33

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17
Q

spinal nerves in column

A

31

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18
Q

what level does spinal cord terminate

A

L1-L3

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19
Q

cauda equina

A

near vertical continuation of spinal nerves from end of cord

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20
Q

5 paraspinal ligaments

A

anterior + posterior longitudinal

interspinal

supraspinal

ligamentum flavum

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21
Q

intervertebral disk

A

outer annulus fibrosis

inner nucleus pulposis

shock absorber

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22
Q

ruptured intervertebral disk

A

annulus fibrosis ruptures, nucleus pulposis protrudes through

disk fragment compresses nerves

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23
Q

how does a ruptured disk produce symptoms

A

nerve compression

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24
Q

1-6 cranial nerves

A

1 olfactory

2 optic

3 oculomotor

4 trochlear

5 trigeminal

6 abducens

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25
Q

7-12 cranial nerves

A

7 facial

8 vestibulocochlear/acoustic/auditory

9 glossopharyngeal

10 vagus

11 spinal accessory

12 hypoglossal

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26
Q

cranial nerve for sight

A

2 optic

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27
Q

cranial nerve for hearing/balance

A

7 vestibulocochlear/auditory/acoustic

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28
Q

3 cranial nerves for eye movement

A

3 oculomotor

4 trochlear

6 abducens

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29
Q

cranial nerve for smell

A

1 olfactory

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30
Q

5 arteries that form circle of willis

A

anterior, posterior, middle cerebrals

anterior, posterior communicating

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31
Q

function of the circle of willis

A

blood through cerebral/cerebellar hemispheres

equalize BP

intracranial circulation

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32
Q

arteries that supply circle of willis

A

r+l internal carotids anteriorly

r+l vertebrals posteriorly

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33
Q

5 common sites of intracranial aneurysm formation

A

anterior, posterior communicating

anterior, middle, posterior cerebrals

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34
Q

3 most common surgical approaches to circle of willis

A

frontal

pterional

bifrontal

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35
Q

first sign of ruptured intracranial aneurysm

A

sudden, severe headache

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36
Q

Bell’s palsy

A

facial lower motor nerve paralysis

  1. facial
37
Q

Meniere’s disease

A

dizziness, sensation of fullness or pressure in ears

  1. vestibulocochlear/auditory/acoustic
38
Q

trigeminal neuralgia

A

severe pain in the face

  1. trigeminal
39
Q

treat tic douloureux

A

glycerol rhizotomy

radiofrequency

balloon compression

microvascular decompression

40
Q

carpal tunnel syndrome

A

compression of the median nerve

41
Q

how to treat carpal tunnel syndrome

A

decompression of the median nerve at the wrist

42
Q

neurectomy

A

division of the vestibular portion of 8th cranial nerve

treats Meniere’s disease/vertigo

43
Q

rhizotomy

A

dissection of a nerve root

44
Q

sympathectomy

A

excision of a portion of the autonomic nervous system

45
Q

neurolysis

A

freeing a nerve from adhesion

46
Q

most frequently encountered neurosurgical problem

A

herniated lumbar disk

laminectomy

47
Q

meningocele

A

failure of the union of vertebral areas in fetal development

48
Q

myelomeningocele

A

meningocele with neural elements

49
Q

cerebrospinal rhinorrhea

A

CSF leak of the nose

50
Q

cerebrospinal otorrhea

A

CSF leak of the ear

51
Q

craniotomy

A

incision into the skull to expose the brain (flap replaced)

52
Q

craniectomy

A

opening into the skull where the bone flap isn’t replaced

53
Q

craniotomy vs. craniectomy

A

in craniectomy the bone flap isn’t replaced

54
Q

why do a craniotomy

A

intracranial hematoma

control bleeding

debulk/resect a tumor

excise/clip vascular lesions

aspirate abscesses

decompress cranial nerves

55
Q

why do a craniectomy

A

remove tumors

hematoma

bone infection

56
Q

cranioplasty

A

repair of a skull defect

57
Q

burr hole

A

small incision from scalp to brain

minimum exposure

58
Q

why do a burr hole

A

remove localized fluid

access ventricles

biopsy

electrode placement

59
Q

epidural vs subdural hematoma

A

epidural: arterial bleeding, increased ICP, more common
subdural: slow collection of venous blood

60
Q

epidural hematoma tear/laceration of what artery

A

middle meningeal

61
Q

vessels commonly responsible for subdural hemorrhage

A

basalar

CHECK

62
Q

lumbar laminectomy

A

excision of one or more lumbar lamina

63
Q

why do a lumbar laminectomy

A

decompress neural tissue

64
Q

positions for lumbar laminectomy

A

prone: most common

modified knee-chest

lateral

65
Q

frames in lumbar laminectomy

A

Wilson: prone

lateral: bean bag

Andrews: knee chest

66
Q

spinal cord stimulator unit

A

implantable, non destructive device

CHECK

67
Q

spinal cord stimulator use

A

chronic intractable pain in trunk/limbs

electrical impulse in epidural space (tingling masks pain)

68
Q

arteriovenous malformation

A

abnormal communication between arterial and venous systems; blood vessel tumor

69
Q

treat AVM

A

excision/ligation

endovascular embolization

70
Q

cervical tongs for neck injury

A

Crutchfield

Garner Wells

Vinke

71
Q

x-ray of choice for acute head injury

72
Q

methylene blue

A

marking ink

inflammatory response in CNS tissue

73
Q

myelography

A

contract in subarachnoid space (spine)

view cord, roots, column

74
Q

WADA’s test

A

before brain surgery to lateralize:

language

memory

dominant hemisphere

seizure/lesion

75
Q

hydrocephalus

A

excessive CSF causes dilation of ventricles

76
Q

external vs internal hydrocephalus

A

external (communicating): abnormal absorption

internal (non-communicating): obstruction of pathways

77
Q

2 surgical shunts for hydrocephalus

A

ventriculoperitoneal

ventriculoatrial

78
Q

common disposable hemostatic scalp clips

A

Raney

LeRoy

mechanical hemostasis of galea/skin

79
Q

3 ways to treat intracranial aneurysms

A

ligation of feeding vessels with clips

fine silk suture

wrap with muslin PMMA

80
Q

mechanical hemostasis

A

physical barrier

patties

clips

gelfoam

surgicel

bone wax

81
Q

chemical hemostasis

A

clotting cascade

surgicel

topical thrombin

absorbable collagen/fibrillar

82
Q

hand-controlled pneumatic driver for burr holes

A

craniotome

83
Q

hand-controlled manually-powered driver for burr holes

A

Hudson Brace

84
Q

hi-powered foot-controlled pneumatic instrument for turning bone flaps or removing laminae

A

Midas Rex

Triton

Saber

85
Q

instrument to remove nucleus pulposis (soft tissue)

A

pituitary rongeur

86
Q

instrument to remove bone spurs from intervertebral laminae

A

kerrison rongeur

87
Q

CUSA

A

cavitron ultrasonic surgical aspirator

hi frequency sound waves

88
Q

CUSA in neuro

A

debulk/emulsify a tumor

hemostasis and spares other tissue

Senior Rotations (8 decks)

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