Neurosurgery Flashcards
(125 cards)
<p>What is the adult prevalence of intracranial aneurysms?</p>
<p>2%</p>
<p>What is the mortality rate of ruptured aneurysms?</p>
<p>30-40%</p>
<p>What percent of ruptured aneurysms develop hydrocephalus?</p>
<p>15-20%</p>
<p>What percent of ruptured aneurysms develop cardiac issues?</p>
<p>50%</p>
<p>Summarize the rupture risk for aneurysm size based on the International Study of Unruptured Intracranial aneurysms? What kind of study was it?</p>
<p>prospective cohort</p>
<p>What percent of bacterial endocarditis patients have mycotic aneurysms?</p>
<p>5-15%</p>
<p>What were the conclusions of the Internation Subarachnoid Aneurysm Trial (ISAT)?</p>
<p>Initially, large difference in mortality favoring coiling over clipping at 1 year. At 5-year follow-up, no difference in mortality between the two groups, though the incidence of rebleeding and aneurysm recurrence was higher in the coiling group</p>
<p>What were the conclusions of the Barrow Ruptured Aneurysm Trial?</p>
<p>initial results at 1 year favoring coiling with regard to poor outcome. At 3-year follow-up, no difference between groups. The rate of recurrence, rebleeding, and aneurysm obliteration were better in the clipping group</p>
<p>What are the general morbidity and mortality for coiling and clipping aneurysms?</p>
<p>mortality (1–2% for surgery/<br></br>coiling) and morbidity (4% coiling and 8% surgery)</p>
<p>What is the hemorrhage rate for AVMs?</p>
<p>2-4% per year,6–18% in first year following initial hemorrhage if not treated. Lifetime risk of hemorrhage is 17–90%.</p>
<p>What is the mortality of AVM hemorrhage?</p>
<p>mortality 10–30%, morbidity 10–30%.</p>
<p>What are dural AVFs?</p>
<p>Pathological shunts between meningeal or extracranial arteries and the dural venous sinus, dural veins, or cortical veins</p>
<p>What is the Borden classification for dAVFs?</p>
<p>Borden I: Generally benign (conversion rate to higher grade ~ 2%), but occasionally symptoms warrant treatment.</p>
<p><br></br>Borden II: Hemorrhage in 18%, annual hemorrhage rate of 6%.</p>
<p><br></br>Borden III: Present with hemorrhage in 34%, annual hemorrhage rate of 10% which increases to 21% with venous ectasia.</p>
<p>What endovascular treatment is preferred for dAVF?</p>
<p>transvenous coiling</p>
<p>Moyamoya in asian adults usually causes \_\_\_\_\_ while in children usually \_\_\_\_\_. In American adults, it usually presents as \_\_\_\_.</p>
<p>hemorrhage</p>
<p></p>
<p>ischemia</p>
<p></p>
<p>ischemia</p>
<p>What is the difference between moyamoya disease and syndrome?</p>
<p>disease: idiopathic</p>
<p></p>
<p>syndrome: secondary</p>
<p>What is the risk of hemorrhage in cav mals?</p>
<p>Risk of symptomatic hemorrhage 0.5–2% per year, may be higher in patients with previous hemorrhages (~5% per year), deep lesions (~10% per year), posterior fossa lesions, familial inheritance, and women (~4% per year)</p>
<p>What does the ICH score predict? What are those values?</p>
<p>mortality at 30 days</p>
<p></p>
<p>ICH score</p>
<p>0: 0%</p>
<p>1: 13%<br></br>2: 26%</p>
<p>3: 72%</p>
<p>4: 97%</p>
<p>5: 100%</p>
<p>6: 100%.</p>
<p>What were the conclusions fo the STICH I and II trials?</p>
<p>supratentorial ICH surgical evacuation only mild benefit in long term mortality</p>
<p>What were the conclusions of the MISTIE trial?</p>
<p>minimally invasive clot aspiration + tPA: 50% reduction in clot burden and at 6 and 12 months increase in number of patients in mRS 0–3 category versus mRS 4 and above</p>
<p>What were the results of the CLEAR trial?</p>
<p>clot lysis of IVH with tPA through external ventricular drain (EVD): mortality rate of 18% in treatment group vs 23% in placebo group, similar ventriculitis rates ~8–9%</p>
<p>Malignant cerebral edema presents in what percent of MCA infarcts?</p>
<p>10%</p>
<p>What is the prevalence of carotid stenosis in the population?</p>
<p>2.5% for age < 65, 35% for age > 75</p>
<p>What percent fo CCFs are from trauma?</p>
<p>70%</p>
What are the types of CCFs?
direct (carotid artery)
indirect (adjacent branch)
What is the presentation for CCFs?
Direct: orbital/retro-orbital pain, chemosis, pulsatile proptosis, ocular/cranial bruit, visual deterioration, diplopia, and ophthalmoplegia.
Indirect: more insidious onset. Conjunctival injection is most prominent feature
What is the management of low flow CCFs?
can be watched until they spontaneously thrombose if visual acuity stable and intraocular pressure < 25 mm Hg. Can also perform daily manual compression of cervical ICA
What percent of subdural empyema have an associated cerebral abscess?
25%
Where is the pterion?
What is the bregma?
located at the junction of the coronal and sagittal sutures
What disease is associated with pilocytic astrocytoma?
NF-1
What is the 5 and 10 yr survival for PXAs?
80 and 70%
What is the most common location for oligodendrogliomas?
frontal lobe (50%)
Most GBMs that develop from other astrocytomas are _____.
IDH mutants
What is the Stupp protocol?
maximal safe resection followed by adjuvant chemotherapy/radiation
fractionated radiation of 2 Gy 5 days/week for six weeks total 60 Gy, plus daily temozolomide at 75 mg/m^2, 7 days a week for 60 days followed by six cycles of adjuvant temozolomide 150-200 mg/m^2 for 5 of 28 days
In the fourth ventricle, ependymomas usually arise from the _____.
floor
Spinal ependymomas are associated with a syrinx in what percent of cases?
90%
"Tiger stripes" in unilaterally in the cerebellum are pathognomonic for _____.
Lhermitte Duclos disease
What is the treatment for Lhermitte Duclos disease?
surgical resection is curative
What is the chance for seizure freedom after DNET resection?
80% at 5 years, 60% at 10 years
What's the difference between a gangliocytoma and ganglioglioma?
Gangloicytoma: WHO grade I growth of mature neurons
Ganglioglioma: WHO grade I and II mixed population of ganglion and glial cells
What is the semiology of hypothalamic hamartomas? What other symptoms can they classically present with?
gelastic seizures
precocious puberty
What is the overall 5 year survival rate for paragangliomas?
90%
What percent of pineoblastomas have CSF seeding?
50%
What is the treatment for pineoblastoma?
surgical resection + cranial/spinal radiation and chemotherapy
What is the survival rate in pineoblastoma?
Fifteen percent 10-year survival in case of residual tumor versus 100% if no residual left
What chromosome abnormality can be seen with medulloblastoma?
loss of 17p in 50% of patients
What is the 5 year survival for medulloblastoma in standrard risk patients (no mets, older than 3 years, Gross total resection)?
100% if ERBB-2 tumor protein negative, 54% if positive
There are many types of meningiomas. What are they and what WHO grade system do they fall under?
WHO Grade I: meningothelial, fibrous, transitional, psammomatous, angiomatous, microcystic, secretory, metaplastic, lymphoplasmacyte-rich.
WHO Grade II: atypical, clear cell (predilection for spinal cord and posterior fossa), chordoid (“chordoma-like”), brain invasive.
WHO Grade III: anaplastic, rhabdoid, papillary.
What is the most common primary CNS sarcome (malignant mesenchymal tumor)?
fibrosarcoma
Soitary fibrous tumors are distinguished form hemangiopericytomas and meningiomas by _____.
CD 34 +
Leiomyosarcomas are associated with what virus?
EBV
What is the median survival in primary CNS lymphoma?
Median survival 1–4 months without treatment, 1–4 years when treated (2–6 months in AIDS)
What is the treatment for germinomas?
biopsy followed by chemo/radiation
50-50 split
"Stalk effect" elevated prolactin levels fall into what range?
25 - 150 ng/mL
For adrenocorticotrophin releasing pituitary adenomas, what medication can be used as a second line treatment?
ketoconazole
What were the results for the Radiation therapy Oncology Group brain metastases trial?
Class 1: KPS > or = 70, < 65 years old, controlled primary with no extra cranial metastases— median survival 7.1 months.
Class 3: KPS < 70—median survival 2.3 months.
Class 2: all others—medial survival 4.2 months
What is the difference in possible meningitis complications in dermoids vs epidermoids?
Epidermoid: aseptic Mollaret recurrent meningitis
Dermoid: septic meningitis
What is the most common location for chrodomas?
Sacrum (50%) and clival (35%)
What type of radiation is most effective for chordoma?
proton beam
What is the role of steroid therapy in acute spinal cord injury?
considered as an option if can start within 8 hours of SCI (methylprednisolone 30 mg/kg over 1 hour then 5.4 mg/kg/hour for 23 hours)
Occipital condyle fractures are due to ____.
axial load
What are the three types of condyle fractures? What are the treatments?
Type I: stable comminuted fracture; treated with collar.
Type II: stable basal skull fracture involving condyle; treated with collar.
Type III: alar ligament avulsion of medial condyle fragment, unstable; treated with halo vest for 6–12 weeks
What is the Rule of Spence?
on open-mouth view, total overhang of both C1 lateral masses > 7 mm = probable transverse ligament disruption and rigid immobilization is required
Odontoid fractures are usually caused by _____.
flexion injuries
What are the types of odontoid fractures? How does the type affect healing and treatment?
Type I: through tip of odontoid, rare, usually stable.
Type II: at base of odontoid, least likely to heal with immobilization, 30% nonunion overall with 10% nonunion if < 6 mm displacement, but up to 70% nonunion if ≥ 6 mm displacement. Surgery indicated if age ≥ 50 years, displacement ≥ 6 mm, instability in halo vest, and nonunion
Type III: through body of C2. 90% heal with immobilization (halo vest preferred)
Hangman fractures are caused by ______.
hyperextension and axial loading (think head first diving)
What are the types of hangman fractures as defined by Effendi? What is the associated treatment for each?
Type I: fracture through isthmus with < 3 mm displacement, stable injury, neurologic injury rare, treatment is collar.
Type II: fracture through isthmus with disruption of C2–C3 disk and posterior longitudinal ligament (PLL) with increased displacement, slight angulation, and anterolisthesis C2 on C3; may be unstable, neurologic deficit is rare, treated with reduction and halo vest for 12 weeks
Type IIa: fracture has less displacement but more angulation than type II, unstable, treated with reduction and halo vest for 12 weeks.
Type III: fracture in which C2–C3 facet capsules disrupted followed by isthmus fracture and possibly anterior longitudinal ligament (ALL) disruption and C2–C3 locked facets, unstable and mostly associated with neurologic deficit, treatment typically open surgical reduction of facet dislocation and fusion
Facet dislocation fractures occur with _____.
flexion distraction injuries
What are tear drop fractures?
Hyperflexion causing injury to disk, facet joints, and all ligaments (highly unstable), associated with small bone chip off anteroinferior vertebral body edge (often mistaken as stable minor avulsion) and posterior displacement of fractured vertebral body into spinal canal. Typically present with severe SCI or anterior cord syndrome. Surgical stabilization required and typically combines anterior decompression and posterior fusion
What is the most common type of thoracolumbar fx?
burst fx
What eprcent of chance fxs have abdominal organ injury?
>50%
