Operations

Question 1

Burr hole

Answer 1

a small hole made in the skull with a surgical drill to expose the dura mater

• to make a larger craniotomy
• to pass drainage catheters that allow CSF drainage
• evacuation of chronic blood

Question 2

Craniotomy

Answer 2

surgical removal of part of the bone from the skull to expose the brain - bone flap is temporarily removed, then replaced after the brain surgery has been done

• different to craniectomy where bone flat not immediately replaced

Question 3

Ventriculo-peritoneal shunt

Answer 3

a shunt that drains CSF fluid from the ventricles into the peritoneal cavity - used to treat hydrocephalus

Question 4

Coiling and clipping of intracranial aneurysm

Answer 4

aim - to prevent aneurysm rupture

coiling:
blocks blood flow into an aneurysm (a weakened area in the wall of an artery) - a catheter is passed through the groin up into the artery containing the aneurysm - platinum coils are then released

clipping (used less nowadays :
open surgical procedure to seal off the aneurysm neck and prevent blood from entering the aneurysm

Question 5

Carpal tunnel decompression

Answer 5

surgery in which the transverse carpal ligament is divided to release pressure on the median nerve
can be open (gold standard), limited open, endoscopic or thread carpel tunnel release

Question 6

Lumbar discectomy

Answer 6

surgery to remove a herniated or degenerative disc in the lower spine

• incision made posteriorly through the back muscles
• a laminotomy is often involved to permit access to the intervertebral disc

Question 7

complications of a burr hole

Answer 7

infection

Question 8

complications of a crantiotomy

Answer 8

infection, bacterial meningitis
postcraniotomy pain*
seizures**

• morphine, nerve blocks
• *phenytoin or leviteracetam 7 days post op to reduce seizure risk

Question 9

complications of a vertriculo-peritoneal shunt

Answer 9

infection
obstruction
over drainage
acquired chiari malformation (one or both cerebellar tonsils sit down through the foramen magnum)
intraventricular haemorrhage

Question 10

complications of aneurysm coiling and clipping

Answer 10

coiling:
stroke
aneurysm rupture during procedure

clipping:
same as craniotomy

Question 11

complications of carpel tunnel decompression

Answer 11

failure 
infection
pillar pain - in hypo/thenar muscles when grasping
median nerve damage
tendon damage

Question 12

complications of lumbar discectomy

Answer 12

postlaminectomy syndrome - chronic back pain
infection
nerve damage