neuro 1 reading (1225-1239)

what does surgery on the nervous system involve?

the brain, spinal cord, peripheral nerves, and the protective structures that surround them

what are common indications for neurosurgery?

congenital defects, traumatic injury, degeneration, and cancer

what instrument sets for craniotomy include?

minor set with basic instrumentation and basic craniotomy or neurological set

Hudson brace with attachments

A

gigli saw handle

B

gigli saw guide

C

gigli saw blade

A

love-kerrison bone rongeur 40 degree forward biting angle

B

ferris-smith spurling bone rongeur

A

style #1 penfield dissector

B

style 2 penfield dissector

C

style 3 penfield dissector

D

stylet 4 penfield dissector

E

stylet 5 penfield dissector

power instrumentation used for neurosurgery includes

midas rex or anspach pneumatic drill with attachments, burrs, bits, air, battery, or electric-powered cranial perforator and craniotome with dura guard, and wire pass air drill with burs and bits

A

Taylor spinal retractor

B

love nerve retractor

C

Scoville nerve root retractor

Scoville brain spatula

Cushing bayonet forceps

A

raney scalp applicator

B

raney scalp clip

A

temporary aneurysm clips

B

permanent aneurysm clips

C

applicator loaded with aneurysm clip

A

microsurgery scissors

B

Jacobson microvascular needle holder

C

rhoton micro forceps

microsurgical instrumentation includes

arachnoid knife, micro-forceps (bayonet types), curettes, scissors, needle holders, dissectors, and bipolar forceps

instrument sets for spinal procedures include

basic laminectomy or neurological set for posterior approaches, anterior cervical diseconomy set

what instrumentation is used fusing the posterior spine (to remove callous and cortical bone from iliac crest)

bone curettes, osteotomes, gouges, large mallet, oscillating saw, gelpi self-retaining retractor, US army navy, hibbs retractor, and perisosteal elevator

peripheral instrument sets include

minor or plastic set

Gardner-wells or mayfield pin fixation device is used for which procedures?

craniotomy

mayfield “horseshoe” headrest is used for which procedures?

cervical spine

wilson frame or Jackson table is used for which procedures?

posterior thoracic or lumbar spine

operating microscope use for neurosurgery?

offers increased illumination and increased visual on the operative field

CO2 laser

can deliver variable amounts of energy to remove small amounts of tissue in tight places

Nd: YAG laser

delivers diffuse energy for better coagulation of bleeding vessels around the target tissue

operative ultrasound machine

used to locate lesions that lie deep beneath the surface of the cerebrum and evaluate the completeness of a tumor resection

frame-based or frameless sterotaxis systems

can deliver an instrument to a target at any point within a defined space, the target space is defined by CT or MRI scanning with reference points attached to the head, various monitoring devices and amplifiers are used in conjunction with these systems

cavitron ultrasonic aspirator (CUSA)

this device emits a variable ultrasonic energy field that emulsifies abnormal tissue while preserving normal neutral tissue, saline ejected from the tip of the handheld unit liquifies the tissue that is then aspirated back to the unit, this instrument is used when a moderate to large amount of tissue is to be removed

pin fixation device

Jackson spinal table

common hemostatic agents for neurosurgery

gel foam, avitene, gelatine powder, thrombin, surgicel, and bone wax

suture used to close the dura?

silk or braided nylon

suture used for wound closure?

polyglactin 910 (vicryl)

suture used for skin closure?

monofilament nylon or stainless steel clips

what is gel foam commonly soaked in?

thrombin

why is bacitracin irrigation never used?

can cause seizures

why should methylene blue never be used?

it exerts neurotoxic effects on the CNS

what are neurosurgeries called when they do not use general anesthesia?

awake craniotomy

what is awake craniotomy performed with?

local anesthesia and sedation

what does an awake craniotomy allow the surgeon?

remove a tumor while the patient is awake to prevent injuring the surrounding brain tissues

cortical brain mapping

used to identify vital areas of the brain that should not be disturbed during the tumor resection

what is the most common approach for procedures?

supine, because it allows exposure to the frontal, parietal, and temporal lobes

a simple donut headrest is used for which procedures?

for superficial tumors or clot removal

what is a lateral or semi lateral position used for?

to expose the unilateral temporal lobe, occipital lobe, brain stem, or cerebellum

what does a sitting position access for?

bilateral access to the occipital lobe, brain stem, or cerebellum

what does a sitting position require?

a 3 pin skull fixation device attached to a frame that attaches to the side rails of the head end of the OR table

what does a prone position gain access to?

bilateral access to the occipital lobe, cerebellum, or brain stem

intracranial neoplasms symptoms and diagnostic tests

headaches, nausea, vomiting, personality changes, and increased intracranial pressure, CT and MRI scans

gliomas incidence and diagnostic tests

40% of primary brain tumors, majority are malignant , CT and MRI scans

astrocytoma grades 1 and 2 incidence and treatment

30 percent of gliomas, most common ages are 30-40, treated with excision and radiation

astrocytoma grades 1 and 2 symptoms and tests

symptoms present for a long period of time, CT and MRI scans

astrocytoma grades 3 and 4 incidence, treatment, and mortality

55% of gliomas, most common ages 50-60, treated with excision, radiation, and chemotherapy, survival is usually less than 12 months

astrocytoma grades 3 and 4 symptoms and tests

same symptoms as 1 and 2 but present for up to 6 months, CT and MRI scans

oligodendroma incidence and treatment

5% of gliomas, most common ages 30-50, treated with excision, radiation, and chemotherapy

oligodendroma symptoms and tests

spontaneous hemorrhage in 40%, calcification present in 50%, occurs along with astrocytomas in 50%

ependymoma incidence and treatment

7% of gliomas, most common in children and young adults, treated with excision and radiation.

medulloblastoma incidence and treatment

most common in children, treated with excision and chemotherapy

meningioma tests and mortality

marked enhancement on CT or MRI, angiography shows characteristic “blush”, they are benign these tumors reoccur if not completely excised

acoustic neuroma incidence, symptoms, and tests

increased incidence with familial history of neurofibromatosis, loss of hearing, headache, vertigo, and facial pain, MRI, CT, audiometry

craniopharyngioma incidence and symptoms

most common in young people, symptoms are headache and behavioral changes

craniopharyngioma tests, treatment, and mortality

MRI, treated conservatively with surgery, usually benign and location determines post operative complications

hemangioblastoma incidence, tests, and treatment

involves the cerebellum, occurs primarily in the young, MRI, excision, radiation when removal is not possible