Supratentorial Craniotomies Flashcards
Which of the following is not an ideal indication of pterional craniotomy?
● A. All aneurysms of anterior circulation
● B. Basilar tip aneurysms
● C. Direct surgical approach to cavernous sinus
● D. Primarily sellar PitNET
● E. Craniopharyngioma
D. Primarily sellar PitNET
What is the head rotation required in pterional craniotomy for exposure of Acom artery aneurysm?
● A. 30 degrees from vertical
● B. 45 degrees from vertical
● C. 60 degrees from vertical
● D. 75 degrees from vertical
● E. 90 degrees from vertical
C. 60 degrees from vertical
What must be linear incision for small craniectomy in temporal region for laterally located vestibular schwannoma?
● A. 0.5 cm anterior to the EAC, extending 7 to 8 cm above the zygomatic arch
● B. 1 cm anterior to the EAC, extending 7 to 8 cm above the zygomatic arch
● C. 0.5 cm anterior to the EAC, extending 3 to 4 cm above the zygomatic arch
● D. 2 cm anterior to the EAC, extending 7 to 8 cm above the zygomatic arch
● E. 1.5 cm anterior to the EAC, extending 7 to 8 cm above the zygomatic arch
A. 0.5 cm anterior to the EAC, extending 7 to 8 cm above the zygomatic arch
Without the use of mapping techniques to localize speech, one can usually safely resect up to how much from the temporal tip in dominant hemisphere?
● A. 3 to 4 cm
● B. 4 to 5 cm
● C. 6 to 7 cm
● D. 7 to 8 cm
● E. 1 to 2 cm
B. 4 to 5 cm
Which of the following points is not considered a danger point during frontal craniotomy?
● A. Motor speech area
● B. Anterior cerebral artery
● C. Sensory speech area
● D. Superior sagittal sinus
● E. Corpus callosum
C. Sensory speech area
Sylvian fissure is considered a danger point in temporal craniotomy owing to the presence of which structure?
● A. ACA
● B. MCA
● C. Wernicke’s area
● D. Sylvian vein
● E. None of the above
B. MCA
All of the following are indications of pterional craniotomies except?
● A. For aneurysms which include anterior circular aneurysms and basilar tip aneurysms
● B. Direct surgical approach to cavernous sinus
● C. Suprasellar tumors like pituitary adenoma or craniopharyngioma
● D. Third ventricular tumors like colloid cyst
● E. Sphenoid wing meningioma tumors
D. Third ventricular tumors like colloid cyst
For pterional approach, skin incision is started 1 cm anterior to the tragus from the zygomatic arch with curving slightly anteriorly and staying behind the hairline to widow’s peak. Which of the following statements are correct regarding position of head?
● A. It is kept 30 degrees from vertical for posterior exposure, for example, for ICA, P comm, carotid terminus, or basilar bifurcation aneurysms
● B. 45 degrees from vertical for middle exposure, for example, for ICA–MCA aneurysms
● C. 60 degrees from vertical for anterior circle of Willis exposure, for example, for a-comm aneurysms, suprasellar tumors
● D. All of the above
D. All of the above
The sylvian fissure can be exposed by starting at a point where the carotid artery penetrates the fissure and working laterally (which is easier when prolific veins overlie the junction of the frontal and temporal lobes) or by working from lateral aspect of fissure medially. Which artery crosses the sylvian
fissure which needs to be spared during opening of fissure?
● A. Middle cerebral artery
● B. Anterior cerebral artery
● C. Internal carotid artery
● D. Artery of sylvian fissure
● E. No artery crosses the sylvian fissure
E. No artery crosses the sylvian fissure
Which of the following are the indications of temporal craniotomy?
● A. Temporal lobe biopsy or temporal lobectomy
● B. Temporal lobe hematoma evacuation or tumors of temporal lobe
● C. Small laterally placed vestibular schwannomas or for access to the floor of the middle cranial fossa
● D. Access to the medial temporal lobe
● E. All of the above
E. All of the above
To access the temporal tip, incision is placed midway between the lateral canthus and which of the following?
● A. Mastoid notch
● B. Tragus
● C. External auditory canal
● D. Inion
● E. Mastoid tip
C. External auditory canal
For dominant temporal lobe lobectomy, safe resection up to 4 to 5 cm from the temporal tip can be used, while on nondominant hemisphere, it is 6 to 7 cm. It is best to amputate the temporal lobe backward from the tip and medially up to incisura to prevent damage to brainstem. What structure of brain is at risk of injury at this region?
● A. Broca’s area
● B. Wernicke’s area
● C. Motor cortex
● D. Auditory brain cortex
● E. None of the above
B. Wernicke’s area
Which of the following are the indications of frontal craniotomy?
● A. Access to the frontal lobe of brain for infiltrating brain tumors
● B. Approach to the 3rd ventricle
● C. Approach to sellar tumors in some situations
● D. Repair of ethmoidal CSF fistula
● E. All of the above
E. All of the above
Danger points in case of frontal craniotomy are the following except?
● A. Anterior cerebral arteries in midline
● B. Injury to Wernicke’s area
● C. Injury to superior sagittal sinus with excessive bleeding
● D. Injury to corpus callosum
● E. Injury to Broca’s area
B. Injury to Wernicke’s area
What is the most commonly injured artery during deep dissection of the sylvian fissure?
● A. Middle cerebral artery
● B. Anterior cerebral artery
● C. Internal carotid artery
● D. Anterior choroidal artery
● E. None of the above
A. Middle cerebral artery
