Flashcards in Neurosurgery Deck (88)
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1
2 structural divisions of nervous system
CNS: brain/spinal cord
PNS: sensory/motor neurons
2
2 functional divisions of nervous system
somatic/voluntary: sensory and motor
autonomic: involuntary, viscera + smooth muscle
3
2 divisions of autonomic nervous system
sympathetic: fight or flight
parasympathetic: calming
4
8 bones of cranium
2 parietal
2 temporal
frontal
occipital
sphenoid
ethmoid
5
foramen magnum
opening in occipital bone where spinal cord passes through
6
3 cranial fossae
anterior: circle of willis
middle: temporal lobes, pituitary, inner + middle ear structures
posterior: occipital lobes, cerebellum, brainstem
7
3 meningeal membranes
dura: superficial, tough, white
arachnoid: middle, thin, avascular
pia: inner, transparent, adhered to surface of cord and brain
8
subarachnoid space
CSF between arachnoid and pia maters
9
principal lobes of cerebrum
frontal
parietal
temporal
occipital
10
3 structures of brainstem
midbrain
pons
medulla oblongata
11
ventricular flow
lateral --> monroe --> 3rd ventricles --> cerebral aqueduct --> 4th ventricle --> lushka, magendie --> basal cisterns (arachnoid villi)
12
where is CSF formed
choroid plexus (ependymal cells)
most in lateral ventricles
13
where is CSF absorbed
arachnoid villi in dural venous sinuses
into venous circulation
14
CSF volume in an adult
80-150ml
15
CSF pressure
10-20mmHg
70-200 mmH2O
16
vertebrae in spinal column
33
17
spinal nerves in column
31
18
what level does spinal cord terminate
L1-L3
19
cauda equina
near vertical continuation of spinal nerves from end of cord
20
5 paraspinal ligaments
anterior + posterior longitudinal
interspinal
supraspinal
ligamentum flavum
21
intervertebral disk
outer annulus fibrosis
inner nucleus pulposis
shock absorber
22
ruptured intervertebral disk
annulus fibrosis ruptures, nucleus pulposis protrudes through
disk fragment compresses nerves
23
how does a ruptured disk produce symptoms
nerve compression
24
1-6 cranial nerves
1 olfactory
2 optic
3 oculomotor
4 trochlear
5 trigeminal
6 abducens
25
7-12 cranial nerves
7 facial
8 vestibulocochlear/acoustic/auditory
9 glossopharyngeal
10 vagus
11 spinal accessory
12 hypoglossal
26
cranial nerve for sight
2 optic
27
cranial nerve for hearing/balance
7 vestibulocochlear/auditory/acoustic
28
3 cranial nerves for eye movement
3 oculomotor
4 trochlear
6 abducens
29
cranial nerve for smell
1 olfactory
30
5 arteries that form circle of willis
anterior, posterior, middle cerebrals
anterior, posterior communicating
31
function of the circle of willis
blood through cerebral/cerebellar hemispheres
equalize BP
intracranial circulation
32
arteries that supply circle of willis
r+l internal carotids anteriorly
r+l vertebrals posteriorly
33
5 common sites of intracranial aneurysm formation
anterior, posterior communicating
anterior, middle, posterior cerebrals
34
3 most common surgical approaches to circle of willis
frontal
pterional
bifrontal
35
first sign of ruptured intracranial aneurysm
sudden, severe headache
36
Bell's palsy
facial lower motor nerve paralysis
7. facial
37
Meniere's disease
dizziness, sensation of fullness or pressure in ears
8. vestibulocochlear/auditory/acoustic
38
trigeminal neuralgia
severe pain in the face
5. trigeminal
39
treat tic douloureux
glycerol rhizotomy
radiofrequency
balloon compression
microvascular decompression
40
carpal tunnel syndrome
compression of the median nerve
41
how to treat carpal tunnel syndrome
decompression of the median nerve at the wrist
42
neurectomy
division of the vestibular portion of 8th cranial nerve
treats Meniere's disease/vertigo
43
rhizotomy
dissection of a nerve root
44
sympathectomy
excision of a portion of the autonomic nervous system
45
neurolysis
freeing a nerve from adhesion
46
most frequently encountered neurosurgical problem
herniated lumbar disk
laminectomy
47
meningocele
failure of the union of vertebral areas in fetal development
48
myelomeningocele
meningocele with neural elements
49
cerebrospinal rhinorrhea
CSF leak of the nose
50
cerebrospinal otorrhea
CSF leak of the ear
51
craniotomy
incision into the skull to expose the brain (flap replaced)
52
craniectomy
opening into the skull where the bone flap isn't replaced
53
craniotomy vs. craniectomy
in craniectomy the bone flap isn't replaced
54
why do a craniotomy
intracranial hematoma
control bleeding
debulk/resect a tumor
excise/clip vascular lesions
aspirate abscesses
decompress cranial nerves
55
why do a craniectomy
remove tumors
hematoma
bone infection
56
cranioplasty
repair of a skull defect
57
burr hole
small incision from scalp to brain
minimum exposure
58
why do a burr hole
remove localized fluid
access ventricles
biopsy
electrode placement
59
epidural vs subdural hematoma
epidural: arterial bleeding, increased ICP, more common
subdural: slow collection of venous blood
60
epidural hematoma tear/laceration of what artery
middle meningeal
61
vessels commonly responsible for subdural hemorrhage
basalar
CHECK
62
lumbar laminectomy
excision of one or more lumbar lamina
63
why do a lumbar laminectomy
decompress neural tissue
64
positions for lumbar laminectomy
prone: most common
modified knee-chest
lateral
65
frames in lumbar laminectomy
Wilson: prone
lateral: bean bag
Andrews: knee chest
66
spinal cord stimulator unit
implantable, non destructive device
CHECK
67
spinal cord stimulator use
chronic intractable pain in trunk/limbs
electrical impulse in epidural space (tingling masks pain)
68
arteriovenous malformation
abnormal communication between arterial and venous systems; blood vessel tumor
69
treat AVM
excision/ligation
endovascular embolization
70
cervical tongs for neck injury
Crutchfield
Garner Wells
Vinke
71
x-ray of choice for acute head injury
CT scan
72
methylene blue
marking ink
inflammatory response in CNS tissue
73
myelography
contract in subarachnoid space (spine)
view cord, roots, column
74
WADA's test
before brain surgery to lateralize:
language
memory
dominant hemisphere
seizure/lesion
75
hydrocephalus
excessive CSF causes dilation of ventricles
76
external vs internal hydrocephalus
external (communicating): abnormal absorption
internal (non-communicating): obstruction of pathways
77
2 surgical shunts for hydrocephalus
ventriculoperitoneal
ventriculoatrial
78
common disposable hemostatic scalp clips
Raney
LeRoy
mechanical hemostasis of galea/skin
79
3 ways to treat intracranial aneurysms
ligation of feeding vessels with clips
fine silk suture
wrap with muslin PMMA
80
mechanical hemostasis
physical barrier
patties
clips
gelfoam
surgicel
bone wax
81
chemical hemostasis
clotting cascade
surgicel
topical thrombin
absorbable collagen/fibrillar
82
hand-controlled pneumatic driver for burr holes
craniotome
83
hand-controlled manually-powered driver for burr holes
Hudson Brace
84
hi-powered foot-controlled pneumatic instrument for turning bone flaps or removing laminae
Midas Rex
Triton
Saber
85
instrument to remove nucleus pulposis (soft tissue)
pituitary rongeur
86
instrument to remove bone spurs from intervertebral laminae
kerrison rongeur
87
CUSA
cavitron ultrasonic surgical aspirator
hi frequency sound waves
88
