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(6) Neurosurgery Flashcards

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1
Q

What is neurosurgery?

A

Surgery performed on the brain or the spinal cord usually for brain and spine tumours, congenital spine defects and vascular lesions

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2
Q

What is a subarachnoid (SA) haemhorrage?

A

Bleeding into the SA usually from ruptured aneurysm at or near the Circle of Willis

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3
Q

What lies in the SA space?

A

Intracranial vessels that give off small perforating branches to the brain tissue

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4
Q

What happens when there is in intercranial aneurysm rupture?

A

Causes intracerebral bleeding with or without a subarachnoid haemorrhage

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5
Q

What is an aneurysm?

A

Localised blood filled dilation of a blood vessel caused by a disease or weakening of vessel wall

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6
Q

What causes an aneurysm?

A

Stretching and thinning of the artery wall over time

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7
Q

What are the two forms of aneurysms?

A
  • Saccular which is a single bulge on one side
  • Fusiform which is a bulge in the middle of the vessel
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8
Q

What are the common sites for aneurysms?

A
  • 85% vessels from the Circle of Willis
  • 20-25% MCA
  • 35-40% ACA
  • 30% internal carotid
  • 10% posterior circulation
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9
Q

What is the most common type of subarachnoid haemorrhage aneurysm?

A

Berry aneurysm (balloon like structure in vessel)

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10
Q

What are risk factors for SAH?

A
  • Age (most common 40-60)
  • F:M (3:2)
  • Hypertension
  • Family history
  • Smoking
  • Cocaine use
  • Alcohol abuse
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11
Q

What are clinical feature of SAH (7)?

A
  • Severe, unrelenting headache (thunderclap)
  • Vomiting
  • Neck stiffness
  • Seizure
  • Lethargy
  • Limb weakness
  • Associated trauma
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12
Q

What are the symptoms and signs of SAH (9)?

A
  • Headache
  • Transient or prolonged loss consciousness
  • epileptic seizure?
  • +/- nausea & vomiting
  • signs of meningism
  • Focal damage
  • papilloedema
  • Reactive hypertension
  • Pyrexia
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13
Q

How is a SAH investigated?

A
  • CT most common diagnosis
  • MRI not routinely used but helps identify multiple aneurysms
  • Lumbar puncture (CSF)
  • Angiography
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14
Q

How is a cerebral aneurysm treated?

A

Surgical treatment
- direct clipping
- balloon embolisation
- wrapping
May be ventilated similar to TBI

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15
Q

What is a complication of SAH?

A

Cerebral Vasospasm

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16
Q

What is cerebral vasospasm?

A

a delayed narrowing of large arteries at the base of the brain after a SAH

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17
Q

When does a cerebral vasospasm usually occur?

A
  • Typical 3-5 days after haemorrhage
  • Maximal narrowing at 5-14 days
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18
Q

What is the treatment for cerebral vasospasm (6)?

A
  • Triple H Therapy
  • keep blood vessels open by increasing the amount of blood to the brain
  • keeping BP up
  • hydration
  • if untreated can lead to cerebral infarcation
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19
Q

What is Triple H Therapy?

A
  1. Hypertension
    - Increase cardiac output & control BP
  2. Hypervolemia
    - intravenous fluids
  3. Haemodilution
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20
Q

What are other complication associated with SAH?

A
  • Rebleeding
  • Hydrocephalus
  • Hyponatremia
  • Seizures
  • Tentorial herniation
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21
Q

What is rebleeding?

A
  • major problem following aneurysm SAH
  • 28 days, 30% rebleed & 70% of those die
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21
Q

What is hydrocephalus?

Study These Flashcards
A

It is an abnormal build up of fluid in the fluid containing cavities in the brain

22
Q

How does hydrocephalus occur?

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A
  • Excessive accumulation of CSF results in widening of spaces in the brain (ventricles)
  • Widening creates potentially harmful pressure on the tissues in brain (increase ICP)
23
Q

When does hydrocephalus occur in patients with SAH?

Study These Flashcards
A
  • Acute occurs within 72 hours in ~20% due to CSF obstruction
  • Further 10% it can develop late
24
What is the management for an aneurysm?
- clipping via craniotomy used to be used - coiling new technique - has less complications & greater survival
25
What does wrapping involve?
- if the width of the aneurysm neck prevents clipping, the muslin gauze may be wrapped around fundus - increased risk of haemorrhage
25
What does coiling involve?
insertion of platinum coil into the blood vessels through small incision under X ray guidance
26
What is involved in physiotherapy during the acute phase of SAH?
- check angiogram results - untreated aneurysm = FLAT BED REST - treated aneurysm = risk developing vasospasm - when stable physio treatment dependent on presenting problems
27
What is Arteriovenous Malformation (AVM)?
- leading cause of stroke in young people - developmental anomalies in the intracranial vasculature (not neoplastic) - "Tangled" blood vessels - capillaries are missing meaning arteries directly connected veins - most common in MCA - usually superficial but can be deep
28
What is the clinical presentation of AVM?
- well-localised headache unilateral & throbbing - +/- nausea & vomiting - cranial nerve involvement? - seizures - hemiparesis - cognitive, language etc
29
How are AVMs investigated?
- MRI - Angiogram - CT scan
30
What is the treatment for AVMs?
- Goal to diminish amount of blood flowing to AVM - Excision (most effective) - Embolization of feeding vessels - May use stereotactic frame - If not treated AVMs will enlarge
31
What is the stereotactic technique?
- Enables accurate placement cannula or electrode in predetermined target - CT & MRI compatible - head ring attached to skull and rods inserted - rods removed and probe inserted using CT
32
What is a brain tumour?
- Growth from different brain cells such as astrocytes, glial cells, lining of ventricles and meninges - Benign or Malignant - Secondary metastases
32
When is stereotactic surgery used?
- Lesions in thalamic nuclei for tremor - lesions globus pallidus - electrical stimulation movement disorders - aspiration of cyst - biopsy for deep tumours - irradiation of small, deep rooted AVMs
33
What are the most common sites of tumours in adults?
- Cerebral 80-85% - Cerebellar 15-20 %
34
What are the most common sites of tumours in children?
- Cerebral 40% - Cerebellar 60%
35
How are brain tumours classified?
- cell type it originates - location it originates
35
What are the pathological classifications of brain tumours?
- Gliomas from glial cells - Meningiomas from meninges - Haemangioblastoma from blood vessels - Neuroma from nerve sheets - Pituitary adenoma
36
What are the most common types of brain tumours?
- Glioblastoma Multiformes (GBMs) most primary (12-15%) - Meningiomas most common benign - 67% brain tumours are gliomas
37
What are the grading of Gliomas?
G1 - pilocytic astrocytoma G2 - diffuse astrocytoma G3 - Anaplastic astrocytoma G4 - Glioblastomas
38
What are Glioblastoma Multiforme (GBM) tumours?
- most common and aggressive tumour - M:F 3:2 - frontal, parietal, temporal, and thalamic regions
39
What causes GBM?
- unknown - genetic abnormalities found
40
What are the symptoms of GBM?
- Headaches - Seizures - Changes in mental status - Personality changes and memory loss - vomiting - reduced consciousness
41
How are GBM's investigated?
- MRI - CT scans
42
What is the treatment of GBM?
- Surgery (partial debulking) - Radiotherapy - Stereotactic irradiation - Chemotherapy
43
What are the complications of surgery for GBM?
- infection - bleeding - oedema - damage normal tissue
44
What are the complications of radiography for GBM?
- oedema - demyelination - radionecrosis
45
What are the complications of chemotherapy for GBM?
- Toxicity - bone marrow suppression
46
What is the mortality for high grade gliomas?
- depends on tumour location, progression, and pressure - many won't survive >3 years
47
Where do meningiomas occur?
Intracranially at the base of the skull close to venous sinuses
48
What are the complications for brain surgery?
- brain damage (primary or secondary) - cerebral oedema - CSF leak - Thrombosis or haemorrhage - DVT - Epilepsy - Infection
49
What should be done on objective assessment with a patient?
- motor - sensory - cognitive - speech - cranial nerves - balance and mobility - functional activity
50
What is involved in physiotherapy for neurosurgery?
- similar to head injury - depends on site and severity - MDT approach - Family involvement - Discharge plan

Neuro (11 decks)

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