Operations Flashcards
Describe intraoperative neuromonitoring
MMEP SSEP Free-running EMG TIVA Short-acting neuromuscular blockade (Other e.g. D-wave can be transcranial motor stim and recording with epidural electrode distal to side of surgery. With loss of motor MEP but preservation of D-wave to 50% above cut off then a temporary deficit is expected post op which is expected to recover long term)
Describe how you would do a pterional craniotomy for MCA aneurysm?
Preoperative and adjuncts - blood XM, ICG, Doppler
Positioning - Mayfield pins, Supine, Head turn, Extension, Malar eminence to ceiling
Approach -
Relevant Anatomy for Procedure
Closure/Post op Instructions
Indocyanine green - fluorescent - dose syringe of 50mg/50mls give 5ml aliquot
What is tisseal?
Fibrin sealant
What is floseal?
Gelatin granules and human thrombin
What is duragen?
Collagen matrix from bovine pericardium
What is surgicel made of?
Oxidised cellulose from plants
What size is the peelaway catheter for neuroendoscopy?
19F
How big’s a neuroendoscope?
Minimum 7mm
What are surface landmarks for ACD?
C1/2 Angle of mandible
C3/4 Thyro-hyoid
C5/6 Cricoid
What’s the surface landmark for sylvian fissure?
Point 3/4 between nasion and inion
Line from lateral orbit to this point
What’s surface landmark for motor strip?
Midway nasion inion and 2cm behind this point
How wide do you decompress for an FMD?
3cm superior and 3cm lateral
How do you do parasagittal craniotomy for meningioma?
Devascularise, Debulk, Dissect
How do you do a carpal tunnel?
Palmar cutaneous branch is external to transverse carpal tunnel
Recurrent motor branch of median nerve (typically comes of distally on thenar side and supplies muscles of thenar eminence)
How would you do a bifrontal craniotomy for trauma?
Key points: Incision tragus to tragus Myocutaneous flap Pericranial flap Frontal sinus Sagittal sinus - paramedian burrholes, thin out and connect Sequence of burrholes and cuts
