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PSA II Exam 1 > Neurosurgery > Flashcards

Neurosurgery Flashcards

(85 cards)

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1
Q

What is a Ventriculoperitoneal shunt (VP) ?

A

A shunt used to drain excessive cerebral spinal fluid from brain hydrocephalus

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2
Q

What causes excessive CSF?

cerebral spinal fluid

A

1) Blockages in ventricular system, can be due to congenital defects or infections
2) Overproduction of CSF, body makes too much and can’t get rid of it
3) poor absorption of CSF to blood vessels

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3
Q

Without a VP shunt, what can patients experience?

A

Brain damage and seizures

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4
Q

Why do adults present more with brain damage and seizures compared to infants?

A

Because adults skull is fused so theres only a limited of space. Infants skill are not fused so they have some more space

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5
Q

What are the 3 parts of a VP shunt?

A

1) Ventricular catheter
2) Shunt Valve
3) Distal catheter

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6
Q

What supplies would you need for positioning for a VP shunt?

A 
Mayfield head rest 
Jelly ring pillow 
Blankets
OR bed 
Safety straps
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7
Q

Where do we want access for a VP shunt?

A

Right skull

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8
Q

How do we want the arms during a VP shunt?

A

Bilateral arms tucked to gain access to both head and abdomen

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9
Q

How is the OR table/bed turned?

A

90 degrees away from anesthesia for better access to the head.

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10
Q

T/F: General surgeon is in OR room during VP shunt

A

True

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11
Q

Name the first 4 steps during a VP shunt

A

1) incision is made behind right ear
2) Burr hole is made into skill
3) Cannula inserted through burr hole into right ventricle
4) catheter is threaded into right ventricle

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12
Q

Name the 4 steps after the catheter is threaded into right ventricle

A

5) Catheter is superficially tunneled down side of head to abdomen
6) The valve is placed at base of skill/posterior neck for easy access
7) A small incision is made on abdomen to gain access to peritoneal cavity
8) A small hole is made in peritoneum and the catheter is threaded into abdomen cavity

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13
Q

How would you close the abdominal incision dermis/skin ?

A

Abdominal Dermis: 3-0 Vicryl

Abdominal Skin: 4-0 Monocryl

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14
Q

T/F: VP shunt can be a two-part surgery

A

True

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15
Q

Abdominal part of surgery can also be performed ____________

A

Laparoscopically

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16
Q

What are the 5 layers of the skull? Outer–> innermost

A 
Skin
Connective tissue 
Aponeurosis (fascia/galia)
Loose areolar tissue 
Periosteum
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17
Q

What is a craniotomy?

A

Surgical removal of part of the skull to expose the brain

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18
Q

Bone flap can be ______ after surgery or _____ for later attachment

A

Reattached

Stored

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19
Q

Why would a patient need a craniotomy surger?

A

1) Epidural/subdural hematoma
2) Tumor resection
3) Aneurysm clipping

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20
Q

What position would be used for a craniotomy?

A

Depends on the location of lesion/trauma

- need to know which lateral side

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21
Q

What materials can be used to stabilize the head for a craniotomy?

A

Mayfield skull clamp
Horseshoe pillow attachment
Jelly Ring pillow

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22
Q

How many parts does a Mayfield skull clamp have and what are they?

A

1) Bed adaptor: attaches directly to bed (slide or pegs)
2) Base unit: attaches to the adaptor
3) Swivel adaptor: comes off base unity and attaches to clamps
4) Skull clamp

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23
Q

What supplies are need for a Mayfield Skull Clamp prep table?

A

1) Mayfield skull clamp
2) Mayfield Skull pins
3) Hair clippers
4) Tape
5) Comb
6) Small plastic bag for hair
7) Marking pen

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24
Q

What instruments/supplies are needed during a craniotomy?

A

1) Rainey Clips: to stop bleeding in highly vascular areas
2) Cottonoids: need to soak in saline and apply tp skull so it doesn’t dry
3) Perforator drill bit
4) Tapered drill bit

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25
Perforator and Tapered Drill Bits are attached to ____
Air power drilled
26
How would you prep and drape the surgical area for a Craniotomy?
1) 4 towels placed around marked site 2) Craniotomy drape place over marked site 3) Meticulous organization of supplies with cords being attached to drapes: so that there is not tangles cords
27
While prepping we should take special care of ____ and ____ _______
Eyes Ear canal
28
What are the 4 steps for opening a craniotomy?
1) incision is made and rainey clips are placed to control bleeding 2) Scalp flap is lifted of skull 3) Perforator drill is used to create burr holes in skill 4) tapered drill is on craniotome attachment to use to connect burr holes
29
What should we use for suction during a craniotomy?
Frazier suction: used/invented for neuro so that the pressure can be controlled
30
What should the SA be extra careful doing while a craniotomy opening?
Needs lots of irrigation so that the bone doesn't burn and don't want to suction brain (causes damage)
31
How is the Dura closed during a craniotomy closure?
Dura is sutured together using a 4-0 Nurolon TF needle (pop off form from 8-pack) Nurolon: braided, permanent and never looses tensile strength
32
____ may be used instead, for dura substitute
Duragen
33
How would we close the skull flap for a craniotomy closure?
Reattached using plate and screws
34
What is done with the skull flap if it is not reattached?
1) Insert into the subcutaneous of the abdomen | 2) Bank skull flap
35
Scalp aponeurosis (fascia) is closed using __ ___ __-1 pop-offs
0 Vicryl CT
36
____ is closed using 2-0 Vicryl CT-1 pop-offs
Dermis
37
Skin is closed using ?
Staples
38
What dressing can we use for a craniotomy?
Telfa- non adherent dressing 4X4s Kerlix head wrap
39
What does TLIF stand for?
Transforaminal Lumbar Interbody Fusion
40
Be able to name the parts of vertebrae
41
What is a TLIF?
Surgical procedure to remove degenerative lumbar vertebral disc and fuse the lumbar spine to eliminate mechanical back pain
42
TLIF is recommended for disabling ______ back and ____ symptoms that have not improved with non-surgical treatments
Lower Leg
43
What are 3 indications for TLIF surgery?
1) Spondylolisthesisa 2) degenerative disc disease 3) Herniated disc
44
What instruments are needed for a TLIF surgery?
1) Cerebellar retractor 2) Nerve root retractor 3) Leksell Rongeur 4) Kerrison Rongeur - Ray tech needed so that bone fragments can be wiped 5) Cobb elevator - Retractor for muscle 6) Woodsen Elevator - Used to peel from bone - Fine dissection sometimes 7) Nerve Hook - Manipulate under bone - Feeling tool 8) Midas rex burr
45
TLIF Position: Patient is _____ on open padded _____ _____
Prone | Jackson Table
46
Patients face is put on a ____ pillow
prone pillow
47
Where are the arms during a TLIF surgery?
Arms are at 90 degrees abduction and flexion
48
Where are the foam padding place during TLIF surgery?
Chest Mid-chest Sternum
49
What should we look for when placing paddings? Females? Males?
Females: check breast Males: check penis and scrotum
50
Relating to hips, where should the pads be placed? Land mark
ASIS: Anterior Superior Iliac Spine
51
Foley is placed ____ we flip the patient prone.
before
52
T/F: Pillows are place under knees and feet are elevated
True
53
What are the first 4 steps during a TLIF procedure?
1) X-ray taken to confirm correct level for decompression and fusion 2) Midline incision is made: (depends on how many levels) a 3-4 cm incision is made per level 3) Dissect through fascia exposing the spinous processes 4) Dissect tissue off spinous and transverse processes exposing facet joints
54
After exposing the spinous and transverse processes, what 4 steps come next?
5) Remove Spinous process with Kerrison Rongeur 6) Perform laminectomy: usually done with burr and irrigation should be done downstream so that visual can be accessed 7) Resect Ligamentum Flavum: removed with kerrison rongeur 8) Unilateral facetectomy performed
55
What 4 steps come after the unilateral facetectomy?
9) Pedicle identified and dissected 10) Box annulotomy: Create window into disk space (using a 15 blade) 11) Disk space distracted and remove from vertebral body 12) Disk space is inserted
56
What occurs after a disk spacer is inserted during a TLIF procedure? 4 steps
13) Pedicle insertion points prepared using burr 14) Awl and pedicle probe used to create pathway for pedicle screws 15) Pedicle tapped according to size estimates 16) Pedicle screws are inserted
57
What happens after a pedicle screws are inserted into vertebrae during a TLIF procedure? 4 steps
17) Rods precut to match curve of patients spine and are inserted into screw heads 18) Cap is placed to capture rod in screw head 19) Pedicle scews are compressed and caps tightened 20) Final x-rays taken to ensure pedicle screw placements
58
What are the last two steps for a TLIF procedure?
21) Bone graft is placed around screws | 22) Drain is placed and fascia is closed using 0 Vicryl CT-1 needle pop offs
59
TLIF closure: Dermis is closed using ___ ___ CT-1 needle pop offs
2-0 Vicryl
60
TLIF closure: | Skin is closed using ____ ____ PS-2 needle
4-0 monocryl
61
What type of stictch is used during closure of skin for a TLIF procedure?
Intracuticular stitch
62
What dressing may be used for a TLIF incision ?
1) Dermabond 2) Steristrips 3) Telfa 4) Tegaderm 5) extra tape to secure drain in place
63
What is a kyphoplasty?
Surgical procedure to releive pain from vertebral compression fractures
64
What can cause Kyphoplasty surgery?
Compression fractures either from osteoporosis or falls
65
How is the patient positioned for a Kyphoplasty surgery?
Patient is prone on a Wilson frame place on flat top jackson table
66
What is necessary at each level of fracture vertebra during surgery?
c-arm
67
What type of surgery is a Kyphoplasty?
Percutaneous Procedure
68
What are the 3 steps for a Kyphoplasty?
1) Needle is inserted into vertebral body under C-arm guidance 2) Balloon is passed though needle and used to expand compression fracture 3) Cement is then inserted into expanded vertebral body to maintain correct position of body
69
What is an ulnar nerve transposition surgery?
Inflamed ulnar nerve is moved more superficially from current location under medial epicondyle
70
Ulnar nerve arises from the _____ cord of the ____ plexus
Medial | Brachial
71
What spinal root is the ulnar nerve
Spinal roots C8-T1
72
Where is the ulnar nerve located?
Runs medially along humerus and ulna, passing under medial epicondyle of humerus through the cubital tunnel
73
What are the sensory function of the ulnar nerve?
Anterior and posterior little finger and 1/2 of ring finger and associated palm area
74
What are the motor function of the ulnar nerve?
- Muscles of hand - Flexor carpi ulnaris - Medial half of flexor digitorum
75
What is cubital tunnel syndrome?
When ulnar nerve becomes compressed or inflamed at the elbow (seen a lot with baseball, tennis, and careers that use arms a lo- repetitive motion with elbow)
76
What are possible causes of cubital tunnel syndrome?
- Prior fracture - Swollen joint - repetitive bending motion at elbow
77
What are symptoms of Cubital tunnel Syndrome?
- Numbness or tingling in ring and little finger - Weakening grip - Muscle atrophy - Difficulty with finger coordination - "Claw finger"
78
What position should patient be in for an Ulnar Nerve Transposition?
Patient should be supine with operative arm extended on a hand table Arms can be left extended on table or flexed at elbow to gain access medially
79
_____ may be used around upper arm
Tourniquet
80
What are the first 2 steps of an Ulnar nerve transposition?
1) Incision made medial to elbow above ulnar nerve | 2) Ulnar nerve dissected from cubital tunnel and surrounding tissue
81
What are the last 2 steps of an Ulnar nerve transposition?
3) Ulnar nerve free from all attachments. Umbilical tape place around either end to gain control of nerve 4) Ulnar nerve transposed to above medial epicondyle of humerus to prevent impingement
82
Ulnar nerve is sutured into new location using 3-0 _____ ____ needle
Vicryl | SH (fine thin needle)
83
The deep ____ is closed using a _____ vicryl SH needle
Dermis 3-0
84
_____ is closed using a 4-0 monocryl PS-2 needle
Skin
85
What dressings can be used for an ulnar nerve transposition?
- Steristrips - 4X4s - Webril - Arm wrapped in 4in & 6in ACE wrap from HAND to ABOVE ELBOW - May be placed in a posterior splint

PSA II Exam 1 (1 decks)

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