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anatomy and physiology skeletal > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

Name the two structural divisions of the nervous system, and briefly describe each

A

CNS: brain & spinal cord

PNS: cranial & spinal nerves

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2
Q

Name the eight bones which form the cranium

A
  • Frontal
  • Occipital
  • Ethmoid
  • Sphenoid
  • Temporal (x2)
  • Parietal (x2)
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3
Q

What is the foramen magnum?

A

Largest opening in the skull, provides passage for the spinal cord to join the brainstem in the posterior fossa

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4
Q

Name and describe the three meningeal membranes and their relationship to the skull and brain

A

Dura mater: in direct contact with the cranium
Arachnoid space: a web like space
Pia mater: in direct contact with the surface of the brain

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5
Q

Name the principal lobes of the cerebrum (4)

A
  • Frontal
  • Parietal
  • Temporal
  • Occipital
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6
Q

What three structures comprise the brainstem?

A
  • Midbrain
  • pons
  • Oblongata
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7
Q

Describe the ventricular system of the brain, and trace the flow of cerebrospinal fluid (CSF) from the sites of production of the sites of absorption

A
  • choroid plexus, lateral ventricles
  • foramen of Monroe, 3rd ventricle
  • aqueduct of Sylvius
  • 4th ventricle
  • foramen Magendie/Luschka
  • sub arachnoid space brain/spinal cord
  • reabsorbed venous sinus blood via arachnoid granulation a
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8
Q

Where (what structure and ventricles) is most CSF formed/produced?

A

Choroid Plexuses/ Lateral ventricle

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9
Q

Where is most CSF absorbed (site and structures)?

A

By fingerlike projections of the arachnoid that project into the dural sinuses called arachnoid villi

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10
Q

What is the average volume of CSF in a healthy adult?

A

125-150mL

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11
Q

What is the average pressure of CSF in a healthy adult?

A

8-14mmHg millimeters mercury

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12
Q

How many vertebrae are there in the spinal column?

A 
*33*
(7 cervical)
(12 thoracic) 
(5 lumbar)
(5 sacral)
(4 coccygeal)
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13
Q

How many spinal nerves are there in the spinal column?

A 
*31*
(8 cervical)
(12 thoracic) 
(5 lumbar)
(5 sacral)
(1 coccygeal)
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14
Q

At what vertebral level does the spinal cord terminate?

A

L1-L3; conus medullaris

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15
Q

Briefly describe the caudal equina

A

downward facing nerves following end of spinal cord
(Lumbar 2-5)
(Sacral 1-5)
(Coccygeal 1)

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16
Q

Name the 5 paraspinal ligaments

A
  • Anterior Longitudinal: runs the length of the column, along the anterior vertebral bodies
  • Posterior Longitudinal: runs the length of the column, along the posterior vertebral bodies
  • Ligamentum Flavum: binds the laminae of adjacent vertebrae
  • Interspinal Ligament: binds the spinous processes of adjacent vertebrae
  • Supraspinal Ligament: runs the entire length of the column, along the posterior spinous processes
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17
Q

Name two functional divisions of the nervous system

A
  • somatic (voluntary)

- autonomic (involuntary

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18
Q

what is the subarachnoid space?

A

CSF filled space between arachnoid mater and pia mater

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19
Q

describe anatomy of an intervertebral disk?

A
  • annulus: fibrous, outer portion

- nucleus pulposus: fluid filled, innermost (jelly donut)

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20
Q

briefly describe the anatomy of a ruptured intervertebral disk

A

radial fissuring of annulus allowing nucleus pulposus to escape

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21
Q

describe how ruptured intervertebral disk produces symptoms

A

nucleus pulposus extends into epidural space causing nerve root compression and radiculopathy (pain from pressure/traction on nerve roots)

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22
Q

cranial nerves 1-12

A
  1. olfactory
  2. optic
  3. oculomotor
  4. trochlear
  5. trigeminal
  6. abducens
  7. facial
  8. acoustic
  9. glossopharyngeal
  10. vagus
  11. spinal accessory
  12. hypoglossal
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23
Q

which cranial nerve is responsible for sight?

A

optic

2nd cranial nerve

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24
Q

which cranial nerve is responsible for sense of balance

A

acoustic

8th cranial nerve

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25
Q

which three cranial nerves are responsible for motor innervation of the eyes?

A

(3,4,6)

oculomotor: 3rd
trochlear: 4th
abducens: 6th

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26
Q

which cranial nerve is responsible for sense of smell

A

olfactory

1st cranial nerve

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27
Q

name the five arteries that form the circle of willis

A
  • Anterior Cerebral
  • Middle Cerebral
  • Posterior Cerebral
  • Anterior Communicating
  • Posterior Communicating
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28
Q

what function does the circle of Willis perform?

A

ensures continuity of circulation in event any of 4 main channels of supply are compromised

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29
Q

name the two arteries (2 anteriorly and 2 posteriorly) that supply the circle of Willis with oxygenated blood?

A

anterior: internal carotid arteries
posterior: vertebral arteries

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30
Q

name five common sites of the intracranial aneurysm formation/

A
  1. anterior communicating art./anterior cerebral art.
  2. posterior communicating art./internal carotid art.
  3. origin of anterior cerebral artery from internal carotid
  4. 1st bifurcation of middle cerebral artery
  5. origin of basilar artery
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31
Q

anterior fossae

A
  • pituitary tumors
  • aneurysms of the circle of Willis
  • limited posteriorly by the sphenoid ridge,
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32
Q

middle fossae

A
  • sella turcica, most central part of the middle fosse
  • pituitary gland housed in most central portion.
  • houses the internal and middle ear structures
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33
Q

posterior fossae

A
  • cerebellum & brainstem
  • largest&deepest formed by the
  • occipital, sphenoid & petrous portion of temporal bones -
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34
Q

flow of CSF

A
  • lateral ventricles choroid plexuses
  • interventricular canal
  • 3rd ventricle
  • aqueduct of sylvius
  • 4th ventricle
  • subarachnoid space
  • circulates brain, spinal cord
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35
Q

name the three most common surgical approaches to the circle of willis (for treatment of aneurysms) (3)

A
  • frontal
  • bifrontal
  • pteronial
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36
Q

What is the most frequently the first sign of a ruptured intracranial aneurysm?

A

-aneurysmal rupture/hemorrhage into subarachnoid space result in extreme splitting headache

37
Q

Briefly describe Bell’s palsy; what cranial nerve is affected?

A
  • facial 7th cranial nerve*
  • lower motor neuron paralysis
  • loss of sensation/control of facial muscles
38
Q

Briefly describe Meniere’s disease; what cranial nerve is affected? (3)

A
  • acoustic 8th cranial nerve*
  • causes spontaneous vertigo
  • dizziness, sensation of fullness, pressure in ears
39
Q

Briefly describe trigeminal neuralgia (tic douloureux); what cranial nerve is affected?

A
  • trigeminal 5th cranial nerve

- excruciating, piercing paroxysms of pain of major peripheral divisions

40
Q

How is tic douloureux surgically treated? (4)

A
  • rhizotomy using glycerol
  • balloon/radiofrequency compression
  • radiosurgery
  • micro-vascular decompression
41
Q

Briefly describe carpal tunnel syndrome; what nerve is affected?

A

entrapment of Median nerve on volar surface of wrist

pain, numbness, tingling of fingers, weakness of intrinsic thumb muscle

42
Q

How is carpal tunnel syndrome surgically treated?

A

decompression of median nerve achieved by incising transverse carpal ligament

43
Q

what is a neurectomy?

A

surgical excision/removal of part or all of a nerve

44
Q

what is a rhizotomy?

A

surgical interruption of cranial or spinal nerve root to treat intractable pain or spastic conditions when other less invasive treatments have failed

45
Q

what is a sympathectomy?

A
  • excision of portion of sympathetic division of autonomous nervous system
  • Tx for Hyperhidrosis or Raynauds disease/phenomenon
46
Q

what is neurolysis?

A

-freeing or loosening of a nerve from surrounding adhesions to restore nerve function or relieve pain

47
Q

What is the most frequently encounter neurosurgical problem, which gives rise to pain due to nerve root compression? What is the procedure most commonly performed to treat the condition?

A

-Intervertebral disc disease; Laminotomy/ Laminectomy

48
Q

describe a meningocele (Pedi Chapter).

A
  • outside skin*
  • failure of union of the vertebral arches during fetal development
  • protrusion of the meninges through a gap in the spine due to a congenital defect forming cyst
49
Q

describe a myelomeningocele (Pedi Chapter).

A
  • inside skin*
  • birth defect in which the backbone and spinal canal do not close before birth, meninges protrude forming sac under skin
  • Type of spina bifida.
50
Q

what is cerebrospinal rhinorrhea (Tabers)?

A

discharge of cerebral spinal fluid from the nose caused by defect or trauma to cribiform plate

51
Q

what is cerebrospinal otorrhea (Tabers)?

A
  • leakage of cerebrospinal fluid form external auditory canal
  • result of prior surgery to ear/mastoid bone or trauma to skull
52
Q

what is a craniotomy?

A
  • incision into the skull to expose the brain of adjacent structures
  • remove lesions
  • treatment of arteriovenous malformations
  • expose and repair intracranial aneurysms.
  • multiple approaches: Frontal, parietal, occipital, temporal or combination
53
Q

what is a craniectomy?

A
  • permanent removal of section of the cranium

- burrs/rongeurs used to extend burr holes

54
Q

how does a craniotomy differ from a craniectomy?

A
  • craniectomy: permanent removal

- craniotomy: temporary removal

55
Q

give some indications/reasons for performing a craniotomy.

A
  • evacuate intracranial hematomas not accessible via burr hole
  • control bleeding
  • resect/debulk tumors
  • excise or clip vascular lesions
  • aspirate excess formation
  • decompress cranial nerves
56
Q

give some indications/reasons for performing a craniectomy.

A
  • craniosynostosis treatment
  • severe head trauma with increased ICP
  • hematoma removal
  • tumor removal
  • infection of bone
  • sub occipital approach grants access posterior fossa
57
Q

what is a cranioplasty?

A

-repair of a skull defect resulting from trauma, malformation, or a surgical procedure.

58
Q

what is a burr hole?

A

-minimal exposure that can be made to gain access to brain

59
Q

why might a burr hole be created (be necessary)?

A
  • treatment of chronic hematomas
  • removal of localized fluid
  • placement of ventricular catheter
  • drain obstructed CSF
  • measure ICP
  • establishment of shunt system
60
Q

describe the difference between an epidural and a subdural hematoma.

A
  • epidural hematoma: result of blow to head causing tear in middle meningeal artery, on the dura mater under the skull. Rapid deterioration of consciousness
  • subdural hematoma: result of venous bleeding, slow forming between dura and arachnoid mater
61
Q

an epidural hematoma most frequently results from a tear or laceration of what artery?

A

-middle meningeal artery

62
Q

what vessels are most commonly responsible for a subdural hemorrhage?

A

-bridging veins in subdural space

63
Q

what is a lumbar laminectomy?

A

removal of one or more vertebral lamina to expose spinal canal

64
Q

why might a lumbar laminectomy be performed?

A

-reach spinal canal and adjacent structures to treat compression fracture, dislocation, herniation of nucleus pulposus, cord tumor, spinal cord stimulation

65
Q

what positions are most frequently utilized for a lumbar laminectomy? Which is most commonly used?

A
  • prone (most common)

- lateral position

66
Q

what types of frames are commonly used in positioning for a lumbar laminectomy?

A
  • wilson frame (prone)
  • wick frame (modified knees to chest)
  • andrews Table (modified knees to chest)
67
Q

what is a Spinal Cord Stimulator unit?

A

-spinal cord stimulator (SCS) implantable nondestructive medical device used to treat chronic pain intractable pain of trunk and limbs

68
Q

why might a Spinal Cord Stimulator unit be employed, and how is it used?

A

-used to treat chronic pain intractable pain by generating electrical impulses to epidural space, producing tingling sensation that masks sensation of pain

69
Q

what is an arteriovenous malformation (A.V.M.)?

A
  • lesions where direct shunting of arterial blood to venous system occurs
  • tightly packed vascular channels increase risk of hemorrhage
70
Q

how is an A.V.M. treated surgically?

A

surgical excision of AVM is recommended

71
Q

name two types of cervical tongs used to employ cervical traction in cases of neck injury (Ortho Ch. Alexander’s).

A
  • gardner wells

- crutchfield

72
Q

what is the diagnostic x-ray study considered the criterion standard for evaluation of acute head injury? (2)

A
  • CT scan

- differences in tissue density easily detectable

73
Q

what is methylene blue, and why isn’t it used on the field during neurosurgery?

A

-causes inflammatory reaction in CNS

74
Q

-what is myelography? Why might it be used?

A

-contrast medium is injected into spinal sub-arachnoid space and fluoroscopy is used to view spinal cord, nerve roots and spinal column to demonstrate a defect involving these areas

75
Q

what is the WADA’s Test? Why might it be used?

A

-used before brain surgery to lateralize language, memory, and the dominant hemisphere.

76
Q

describe the condition known as hydrocephalus.

A
  • condition resulting from accumulation of CSF resulting in dilation of ventricular system (produces/circulates CSF)
  • can result in spina bifida, tumors, intracranial/intraventricular hemorrhage, aqueductal stenosis
77
Q

describe the difference between external (communicating) and internal (non-communicating) hydrocephalus.

A
  • communicating: unobstructed flow; problem with reabsorption results in increase ICP
  • non-communicating: obstructed flow in ventricular system results in increased ICP
78
Q

describe the two most frequently employed surgical shunting procedures used to treat hydrocephalus.

A
  • externalized ventralostomy catheter: catheter inserted into right or left lateral ventricle via burr hole; distal catheter externalized and connected to drain to control drainage of CFS and monitor ICP
  • internalized VP shunt: one way valve system directs flow of CSF out of ventricular system; controlled and uncontrolled valve systems exists;
79
Q

give an example of commonly used disposable hemostatic scalp clips. How, why and when are they used?

A
  • raney or Leroy scalp clips
  • applied during primary incision; removed during closure
  • used as temporary wound pressure for hemostasis
80
Q

describe the three manners of surgically treating intracranial aneurysms.

A
  • aneurysm clips

- endosaccular occlusion

81
Q

describe mechanical hemostasis; give several examples of mechanical means of hemostasis.

A
  • hemostatic clips
  • bone wax
  • ESUs
82
Q

describe chemical hemostasis; give several examples of chemical means of hemostasis.

A
  • tompical thrombin
  • FloSeal
  • absorbable gelatin (gelfoam)
  • collagen hemostat (avitene, helistat)
  • oxidized regenerated cellulose (surgicel)
83
Q

name and describe the surgical approach for the procedure known as a transsphenoidal hypophysectomy.

A
  • endoscopic transphenoidal approach: Pituitary fossa reached through sphenoidal sinus by transnasal route
  • hyphosectomy: complete extracapsular enucleation of pituitary
84
Q

name the hand-controlled manually-powered driver/instrument (twist-drill) that is used to create burr holes (perforate the skull).

A

-hudson Brace

85
Q

name the hi-powered, foot-controlled pneumatic instrument that is used to “turn” bone flaps (during craniotomy) and/or remove laminae (during laminectomy/laminotomy).

A

-Midas Rex pneumatic drill

86
Q

name the instrument that is used to remove nucleus pulposus (soft tissue) from the intervertebral disk space during a laminectomy/laminotomy.

A

-pituitary rongeur

87
Q

name the instrument that is used to manually remove bone (spurs/osteophytes) from the intervertebral foramina and/or laminae (during laminectomy/laminotomy).

A
  • kerrison Rongeur

- leksell Rongeur

88
Q

what is the C.U.S.A. (what does it stand for)? Describe its mechanism of action.

A
  • cavitron Ultrasonic Activator
  • emits ultrasonic energy field emulsifying abnormal tissue while preserving normal tissue.
  • saline emitted from tip emulsifies tissue and CUSA aspirates simultaneously
89
Q

how/why is the C.U.S.A. utilized in neurosurgery?

A

-effective for removing abnormal tissue while preserving normal neural tissue

anatomy and physiology skeletal (9 decks)

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