Neurosurgery Flashcards
I
II
III
Olfactory nerve
Optic nerve
Oculomotor nerve
IV
V
VI
Trochlear nerve
Trigeminal nerve
Abducens nerve
VII
VIII
IX
Facial nerve
Vestibulocochlear nerve
Glossopharyngeal nerve
X
XI
XII
Vagus nerve
Accessory nerve
Hypoglossal nerve
The spinal column consists of how many vertebrae?
33 vertebrae
List the vertebrae numbered by location:
7 cervical, 12 thoracic, and 5 lumbar
5 fused sacral vertebrae
4 fused coccygeal vertebrae
CNS
PNS
Neuron
Central nervous system that consists of the brain and spinal cord
Peripheral nervous system that consists of the nerves and ganglia outside the brain and spinal cord
Nerve cell that receives and sends electrical signals throughout the body
Neuroglia
Glioma
Sella turcica
A type of cell that form the supporting structure and provide them with insulation for the neurons
A malignant tumor that occurs in the brain and spinal cord
A depression in the sphenoid bone in which the pituitary gland is situated
Foramen
CSF
Corpus callosum
An opening or a hole in the bone
Cerebrospinal fluid
A broad band of nerve fibers that divides the brain into the right and left hemisphere
Craniosynostosis
Gyri-
Sulci
Premature closure of cranial sutures
A ridge on the cerebral cortex (surface of the brain)
A groove or fissure on the surface of the brain
Hydrocephalus
Meningocele-
Myelomeningocele
PLIF
Accumulation of fluids that enlarges the brains and sometimes causing brain damage
Aprotrusion of meninges through a defect in the skull or spinal column. It is a cyst filled with cerebrospinal fluid (CSF)
A birth defect where the spinal canal and the backbone do not close (spina bifida).
Posterior lumbar interbody fusion is a type lower back spinal fusion
List the layers of the scalp (from outside in):
Skin Fat Galea aponneurotica Periosteum Bone (skull) Dura Arachnoid mater Pia mater
List the four single cranial bones:
Sphenoid bone
Ethmoid
Frontal
Occipital
List the 3 parts of the brain stem.
Medulla
Pons
Midbrain
List the cerebral ventricles.
Right Lateral Ventricles.
Left lateral ventricles
Third Ventricle
Fourth Ventricle
Define Carotid endarterectomy
Removal of atheroma (plaque) from inside the carotid artery
Anatomy/physiology
Pathophysiology/Indication Carotid endarterectomy
Common carotid artery
Carotid bifurcation
Internal and external carotid arteries
Jugular vein
Sternocleidomastoid muscle
Physiology: Blood supply to head, neck, brain
Carotid stenosis (indication) due to atherosclerosis (pathology)
Procedure Steps for Carotid endarterectomy
I/H/D/R (Metz; DeBakeys; Weitlaners)
Isolate common carotid artery; internal and external carotid arteries; place vessel loops (Short right angles; tags)
Heparinize patient; place clamps
Arteriotomy with #11 on #7 handle and Potts-Smith vascular scissors
Remove plaque (Freer elevator; mosquitos; fine right angles; vascular DeBakeys; moist raytec to clean instruments of pieces of plaque)
Irrigate artery, close arteriotomy; patch PRN
(7/0 Prolene double-armed MS; tack intima)
(6/0 Prolene double-armed; arteriotomy)
Remove clamps, flush, finish closing arteriotomy, I/H/C/D
Define Abdominal aortic aneurysm
abdominal aortic aneurysm
an enlargement or ballooning of a blood vessel
Placement of a graft to bypass a ballooning of the abdominal aorta.
Anatomy/physiology
Pathophysiology/Indication Abdominal aortic aneurysm
Retroperitoneum
Aorta
bifurcation to iliac arteries and then on to femoral arteries
Posterior aorta: lumbar arteries
Renal arteries, kidneys
Ureters
Vena cava (slightly to the right)
Physiology: Blood supply to lower body
Abdominal aortic aneurysm due to atherosclerosisProcedure Steps for Abdominal aortic aneurysm
I/H/D/R (FYI: Large self-retaining retractor, e.g., Bookwalter)
Open retroperitoneal space; expose and isolate aorta/aneurysm
Heparinize patient; clamp aorta proximally and distally
Open aneurysm, remove plaque; suture-ligate lumbar perforators
(FYI: #10 on long 3; long curved Mayos; 2/0 silk SH)
Select graft; anastomose proximally then distally; flush; remove clamps
Close aneurysm walls over graft (NIT); re-peritonealize
I/H/C/D
Define Thoracoscopy (VATS)
Visual exam; chest cavity
Video-assisted thoracic surgery
Anatomy/physiology
Pathophysiology/Indication Thoracoscopy (VATS)
Lung; lobes (3 right; 2 left)
Bronchi
Pulmonary arteries/veins
Ribs; intercostal muscles
Pleurae (parietal and visceral)
Diaphragm
Mediastinum
Pericardium
Physiology: respiration
diagnostic procedure
Treatment for:
Peripheral lung lesion (do a wedge resection)
Lung tumor (lobectomy)
Excessive pericardial fluid (do a pericardial window)
Pulmonary blebs (like blisters; resect affected areas)
Pleural effusion (drain/possible pleurodesis)
Emphysema (lung volume reduction)Procedure steps for Thoracoscopy (VATS)
Incision
Insert port; insert scope & camera; EUA
Place other ports and instruments
Treat PRN:
Make a pericardial window with endoshears
Resect bleb with endo-GIA stapler
Perform wedge biopsy with endo-GIA stapler x 2
Perform lobectomy by dissecting and resecting with staplers
Perform pleurodesis with kitners; talc with Lukens tube or Asepto
Drain effusion with suction
Resect “floppy” lung segments for emphysema
Remove instruments; insert and secure chest tubes; C/D
Define Craniotomy
Incision into the skull
Anatomy/physiology
Pathophysiology/Indication Craniotomy
Skin, subcutaneous tissue, galea (AKA: epicranial aponeurosis), periosteum (AKA: pericranium); muscle
Cranium
Dura
Brain
Physiology: cognition; coordination; emotion; memory; reflex
Hematoma
Epidural – above or upon the dura
Subdural – under the dura
Aneurysm
Ballooning of a blood vessel
Brain tumorProcedure steps Craniotomy
IHDR
Incise scalp flap; hemostasis with ESU and scalp clips
FYI: segments; traction stitches; old technique is Dandy secure by everting it over a sponge (scalp roll; to maintain circulation to flap)
Create bone flap and place flap in secure place on back table
FYI: Perforator for burr holes x 3-4; craniotome to connect holes
FYI: subdural may just require burr holes
Create dural flap
FYI: 15 blade; baby Metz; traction sutures; secure over everted scalp flap
Place self-retaining or hand-held retractors
Treat condition as specified:
A hematoma is evacuated; hemostasis achieved; drain is placed
Aneurysm is exposed; clips are carefully placed;
Tumor is exposed; dissected; and removed
Irrigate using body temperature saline
Meticuloushemostasis is achieved; place drain PRN (hematoma);
The wound is closed in layers by:
Close dura with 4/0 silk SH CR interrupted
Replace and secure bone flap by drill/place wires; or with plates and screws
Close scalp with 2/0 vicryl CT-2 CR interrupted and skin staples
Dress
Define Laminectomy, lumbar
Removal of the lamina (vertebral arch) to access intervertebral disk
Anatomy/physiology
Pathophysiology/Indication Laminectomy, lumbar
Vertebral body
Transverse processes
Spinous process
Lamina
Intervertebral disk
Annulus and nucleus pulposus
Spinal nerve roots
Ligament of Flavum
Epidural fat and epidural veins
Extradural space
Physiology:
Skeletal portion: support and movement
Disk portion: cushion between vertebral bodies
Nerve portion: motor and sensory
Ruptured intervertebral disk (IVD)
Degenerative disk disease
Spinal stenosis; Spondylolisthesis; Compression fracture/dislocation; Spinal cord tumorProcedure steps Laminectomy, lumbar
I/H/D/R (FYI: Beckman; Scoville)
Remove portion of laminar arch with Kerrison rongeurs
Incise ligament of Flavum
(FYI: 15 on # 7; Protect dura w/ cottonoids)
Explore space; retract nerve root
(FYI: blunt probe and Love nerve root retractor)
Remove IVD in fragments with pituitary rongeur
(FYI: incise annulus; then pituitary rongeur)
Probe to verify all fragments removed
I/H/C/D
What large and vital structure is deep to the spinal column?
Aorta
atheroma
Fatty plaque
Oma-tumor
cranial nerves running near carotid artery
Cranial IX: glossopharyngeal
Cranial X: vagus (and branch – laryngeal nerve)
Cranial XI: accessory
Cranial XII: hypoglossal
