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Neurology > Neurosurgical Procedures > Flashcards

Neurosurgical Procedures Flashcards

1
Q

What is Sterotaxy?

A

Biopsy / Deep brain stimulation
3D reconstruction of brain tissue w/ CT/MRI
(real-time guided navigation for neurosurg procedures)

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2
Q

Vagal nerve stimulator insertion can be performed to Tx what kind of condition.

A

Inhibit seizure like activity.

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3
Q

What are some potential causes of ICP which should remain on your differential?

A 
Traumatic Brain Injury
Hematoma or contusion
Midline shift
Compression of basal cisterns
Hydrocephalus
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4
Q

What is a normal ICP range?

A

7-15

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5
Q

When would CSF diversion be indicated and how does it work?

A

Ventricular Peritoneal (VP) Shunt

Redirects CSF away from ventricles to the abdomen –> reduces ICP and allow the ventricles to escape compression in fixed cranial vault from increased CSF vol

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6
Q

What are some indications for Burr holes

A

Epidural hematomas

Subdural hematomas

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7
Q

CPP Cerebral Perfusion Pressure
CPP = MAP - ICP

What is the desired CPP for PTs? Why is this value important?

A

The Cerebral Perfusion Pressure is important because it is a measurement of cerebral perfusion… If the ICP is too high for example, the brain cannot perfuse.

Normal Values = 50 - 150

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8
Q

What are some indications for using 3D reconstruction or MRI guidance to target lesions in suspected PTs?

A 
Arteriovenous malformation
Brain metastases
Pituitary adenoma
Meningioma
Trigeminal neuralgia
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9
Q

When would deep brain stimulation be indicated for a PT?

A 
Parkinson's Dz
Tremor
Dystonia
Epilepsy
Tinnitus
Neuropathic Px

Implantation of electrodes will regulate abnormal impulses

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10
Q

When would a laminectomy be appropriate for a PT?

A 
Spinal stenosis
Sciatica
Osteoarthritis
Degen Disc Dz
Herniated Disc
Ankylosing spondylitis
Posterior tumors
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11
Q

When would a discectomy be indicated instead of a laminectomy?

A

If RADICULAR SYMPTOMS are present (same indications otherwise)

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12
Q

High level of suspicion of what conditions/diseases would justify ordering a lumbar puncture for a PT?

A 
CNS infection (Dx or r/o meningitis)
Idiopathic intracranial HTN (pseudotumor cerebri)
Carcinomatous meningitis 
Tuberculosis meningitis 
Normal pressure hydrocephalus
Syphilis w/ CNS involvement
CNS vasculitis 
(Can also rarely Dx MS, Guillain-Barre, or paraneoplastic syndromes)
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13
Q

Lumbar punctures may be required to carry out certain therapeutic treatments/procedures as well: examples might include…

A

Spinal anesthesia
Chemo
Abx
Inj. of contrast media for myelography or cisternography

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14
Q

Before performing a lumbar puncture: what 4 considerations or contraindications you should keep in mind?

A
  1. Increased Cranial Pressure
    ~~Can increase risk for cerebellar or cerebral brainstem herniation
  2. Anticoagulation therapies on board (increased epidural hematoma risk)
  3. Cellulitis or abscess (infxn introduction of abscess into CNS/CSF during LP)
  4. DJD or hardware –> order fluroscopy
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15
Q

What are some potential complications from a performed lumbar puncture?

A 
Brainstem herniation
Accidental puncture of aorta, vena cava, or retroperitoneal vessels
Accidental puncture of spinal cord
Infxn introduction into the CNS
Headache: due to CSF leak
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16
Q

Where is a lumbar puncture performed? What are the anatomic landmarks?

A

L3/L4 space

Superior iliac crests –> move across to midline

17
Q

What position should the patient be in during a Lumbar Puncture?

What needle angle insertion method should be used?

A

Cephalad angle
Bevel oriented w/ LONGITUDINAL fibers
Reduces tissue damage by separate fibers and not cutting them

18
Q

PT is in left lateral decubitus position… Which way should the bevel be oriented?

What if the PT was upright?

A

Bevel upwards –> Left lat decubitus

Bevel L or R –> PT is upright

19
Q

A PT has presented with positive Phalen Test and Tinel’s sign with significant Px, numbness, and tingling of the hands requiring surgical intervention. Which anatomical structure will be cut to alleviate pressure on the median nerve?

A

Transverse carpal ligament

20
Q

PT has difficulty controlling fingers, and numbness/tingling of the ring and pinky fingers is present. Surgical intervention is indicated for this PT; what anatomical structures will be modified?

A

Roof cubital tunnel is opened

(Transposition of the nerve may be required)

Ulnar Nerve Decompression**

21
Q

The Pain Specialist tells you to go prepare the PT room for a CSF Diversion- LP (Lumbar Peritoneal) shunt… What will you need to get?

A 
Radio-opaque lumbar catheter 
Tuohy Needle (14gauge; 11cm)
Peritoneal catheter 
Intermediary catheter
Leur-lock connector

Neurology (18 decks)

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