Neurosurgery Self Study packet, part II

The layer of meninges that lies in intimate contact with the brain is the

pia mater

Normal constituents of CSF are

protein, glucose, electrolytes, lymphocytes, some pituitary hormone, and water

The brain is composed of five fairly distinct components. The largest part of the brain is the

cerebrum

How many lobes of the cerebrum are there?

4

Which part of the brain is the “sensory” integrating center?

The thalamus

The hypothalamus has many functions. What are they?

Circadian rhythm, regulation of body temp, metabolism balance, water balance

The pons is considered a portion of the brain stem is responsible for

forming a bridge between the two halves of the cerebellum, and the medulla oblongata and midbrain

How long approximately is the spinal cord?

About 16 to 18 inches

The terminal bundle of fibers of the spinal cord is known as the

cauda equina

What are the two divisions of the autonomic nervous system?

The parasympathetic and sympathetic nervous systems

The center for sight is located in which lobe of the cerebrum?

The occipital lobe

Absence of a brain is known as

anencephaly

Another name for a cyton is the

cell body

Most nerves are mixed nerves, meaning that they

contain both afferent and efferent fibers

Equilibrium is maintained through control of the skeletal muscles and is regulated by the

cerebellum

The division of the brain which controls body movement is the

cerebrum

The deep groove which divides the cerebrum into two halves is called the

longitudinal fissure

The papillary center which controls the size of the pupil is found in the

midbrain

The nerves which control the movement of the diaphragm are the

phrenic nerves

The Foramen Magnum is located in the

skull

The spinal cord extends down to between which two vertebrae?

L1 and L2

The point of contact between the axon of one neuron and the dendrites of another neuron is called the

synapse

The functioning unit of the nervous system is the

neuron

Efferent nerves are those which

carry impulses away from the CNS

The portion of the neuron that receives the message is called the

dendrite

Afferent nerves are those which

carry impulses toward the CNS

The function of the neurilemma is

regeneration

An axon conducts

impulses away from the cell body

How many lobes does the cerebrum have?

Four

The membrane which lies proximal to the cranium is the

dura mater

The deep groove which divides the cerebrum into two halves is called the

longitudinal fissure

What are three functions of CSF?

Protect the brain and spinal cord, help support the weight of the brain, and bathe the brain and spinal cord

The spinal cord is the conduction pathway to and from where?

The higher centers of the brain

The medulla oblongata is (3)

where the brain and spinal cord unite; where nerve fibers cross over, giving the right side of the brain control of the left side of the body and vice versa; the location of the respiratory, cardiac, and vasomotor centers

The three layer membrane that protects the brain and spinal cord and consists of the dura mater, arachnoid, and pia mater is called

the meninges

The membrane that lies in contact with the brain is the

pia mater

Which of the following is not a layer of the scalp?

a) skin

b) muscle

c) glia

d) they are all layers of the scalp

d) they are all layers of the scalp

The space around the brain and spinal cord which contains CSF is known as the

subarachnoid space

The nerves which lie outside of the CNS are called

peripheral nerves

The master gland located in the cerebrum is the

pituitary gland

The reflex center is located in the

medulla oblongata

There are how many pairs of cranial nerves?

12

There are how many pairs of spinal nerves?

31

The average weight of an adult brain is approximately

three pounds

Equilibrium is regulated by which main part of the brain?

The cerebellum

The average amount of CSF in a human is

135cc

Raney clips are

hemostatic scalp clips

Which operative procedure facilitates the draining of a subdural hematoma?

Burr holes with durotomy

Hemostasis in neurosurgery is achieved by using gelfoam saturated with saline or what?

Topical thrombin

A tumor arising from the covering of the brain is called a

meningioma

Which cautery is most commonly used during neurosurgical cases?

Bipolar

All of the following are used for hemostasis in neurosurgery except:

a) bone wax

b) neuro patties

c) bipolar

d) heparin

d) heparin

What can be used to close a bone flap after a craniotomy?

Stainless steel suture, and/or titanium mini plates and screws

In a laminectomy, herniated disc fragments are removed with which surgical instrument?

A pituitary rongeur

A ventriculoperitoneal shunt is placed to treat

hydrocephalus

During which procedure could a gigli saw be used?

During a craniotomy

What is the only position that can be used to perform a laminectomy?

Prone

What instrument is used to excise the lamina overlying the herniated disc during its removal during a laminectomy?

A kerrison rongeur

What is the incisional approach used for a transphenoidal?

Middle of the upper gum

Craniosynostosis is defect due to

premature closure of the cranial sutures

What are contraindications for performing a lumbar puncture on a patient?

Presence of infection at puncture site, increased ICP, and suspected intracranial tumor

Because the ___ and ___ are essentially insensitive to pain, local anesthetic is generally sufficient for diagnostic and neurosurgical procedures.

brain; spinal cord

Tic douloureaux causes pain on one side of the face along the sensory distribution of which cranial nerve?

The trigeminal nerve, or fifth cranial nerve

The spinal cord extends from where to where?

From the foramen magnum to between the first and second lumbar vertebrae

A craniotomy wound is irrigated frequently with NS or LR for

hemostasis

Following an intracerebral hemorrhage or stroke on the right side of the brain, the patient will usually develop paralysis where?

On the left side of the body

Introduction of contrast medium into the subarachnoid space of the spinal canal is involved in which diagnostic procedure?

Myelography

In neurosurgical operations, osseous bleeding is controlled with

bone wax

Which is the correct position for an anterior cervical discectomy and fusion (ACDF)?

Supine with the head turned toward nonaffected side

Instruments that could be used to open the skull

Drill or perforator, Midas Rex, gigli saw

What are the three main rongeurs used in spinal surgery?

Leksell, Kerrison, pituitary

A laminectomy may be done for (three)

intractable pain, spinal cord tumors, or a herniated intervertebral disc

Laminectomy, discectomy, and rhizotomy are all neurosurgical procedures performed on what specifically?

The spine

The most common donor site for bone in a spinal fusion is the

iliac crest

Which of the following is an example of an aneurysm clip?

paper clip, towel clip, sugita clip, rainey clip

Sugita clip

Fracture of the C-spine may require

tongs and traction (a halo)

What are the four main approaches to a craniotomy?

Frontal, temporal, parietal, occipital

Bones of the skull are joined by seams known as

sutures

A common diuretic given to a patient to decrease ICP is

Mannitol

What is the name of the diagnostic procedure where air is introduced into the lateral ventricles and X-rays are taken to diagnose tumors?

Pneumoencephalography

What are the steps for turning a bone flap?

Incision, raise a muscle flap, perforator, craniotome

Scalp bleeding can be corrected using

dandy clamps, scalp clips, epinephrine

The best way to control bleeding on the cut edges of the skull is

with bone wax

What is the best temperature for irrigation used on the brain?

Body temperature

While closing a craniotomy, what is closed after the dura?

The bone flap

Meningioma

tumor of the coverings of the brain

Scoliosis

curvature of the spine

Spina bifida

nonclosure of the vertebral canal

Craniosynostosis

premature closure of the cranial sutures

Angioma

tumor made up of blood vessels

Meningocele

herniation of the meninges through an abnormal opening in the vertebral canal

Meningomyelocele

herniation of the meninges and the spinal cord through an abnormal opening in the vertebral canal

Neurofibroma

tumor of cranial nerve fibers

Tic douloureux

trigeminal neuroglia

Nucleus pulposa

material that herniates from an intervertebral disc