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From Flashcardlet > Neurosurgery SP1 > Flashcards

Neurosurgery SP1 Flashcards

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1
Q

Vertebral column

A

flexible, bony frame extending from foramen magnum of skull to coccyx

supports weight of head/trunk

protects spinal cord

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2
Q

of vertebrae and # of spinal nerves?

A

33, 31

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3
Q

Vertebra

A

oval cancellous body

vertebral foramen posterior to body w/ 2 processes called pedicles and laminae (2)

form protective ring (vertebral canal)

spinous process posteriorly is attachment point

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4
Q

Intervertebral disk

A

elastic fibrocartilaginous cushion

amphiarthrotic joint

flexibility of column/shock absorber

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5
Q

2 regions of intervertebral disk

A

annulus fibrosis: outer donut fibrocartilaginous ring

nucleus pulposis: inner soft pulpy elastic mass

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6
Q

5 paraspinal ligaments

A

linear stability/flexibility

anterior/posterior longitudinal

ligamentum flavum

interspinal

supraspinal

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7
Q

5 vertebral regions

A

cervical (7)

thoracic (12)

lumbar (5)

sacral (5)

coccygeal (4)

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8
Q

Common characteristics of vertebrae

A

cervical: small body wide foramina
thoracic: larger bodies narrower foramina
lumbar: thick bodies narrow foramina
sacral: fused
coccygeal: fused

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9
Q

What level does the cord terminate?

A

L1-L3

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10
Q

Near-vertical continuation of spinal nerves from the end of the cord?

A

cauda equina to Co1

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11
Q

3 meningeal layers

A

outer: dura
middle: arachnoid
inner: pia

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12
Q

Herniated vertebral disk

A

annulus fibrosis ruptures and nucleus pulopsis protrudes through

disk fragment compresses neural structures causing pain or neural deficit

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13
Q

Herniated lumbar disk

A

lower back pain w or w/o radiating leg pain of the calf and thigh

parasthesia of calf/foot

loss of reflexs

weakened quad + atrophy

foot drop

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14
Q

Where do most disk herniations occur?

A

L4-L5, L5-S1

2nd most common C6-C7, C7-T1

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15
Q

Diagnostic test of choice for soft tissue disk herniation

A

MRI

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16
Q

Diagnostic test of choice for bony abnormalities

A

CT scan

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17
Q

Antiquated diagnostic test involving injection of contrast media into the spinal sub-arachnoid space with x-ray

A

myelogram

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18
Q

Laminectomy

A

excision of one or more vertebral lamina to expose the spinal canal (decompresses neural tissue)

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19
Q

Laminotomy

A

limited division of lamina to expose spinal canal

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20
Q

Discectomy

A

excising of a herniated disk fragment

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21
Q

3 common positions for lumbar laminectomy

A

prone, modified knee-chest, lateral

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22
Q

Positioning aids in prone

A

wilson, kambin, hastings frames

chest roll

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23
Q

Positioning aids for modified knee-chest

A

andrews, hick frames

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24
Q

Prevent DVT and subsequent pulmonary embolism

A

anti-embolitic stockings

sequential compression stockings

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25
Two common incisions for lumbar laminectomy
vertical midline transverse over affected disc space
26
3 superficial self-retaining retractors used in lumbar laminectomy
cone, weitlaner, beckman
27
6 deep self-retaining retractors for lumbar laminectomy
meyerdig williams scoville tower crank McCullough
28
4 hand held nerve root retractors
scoville D'errico love copper
29
5 powered drills for grinding down laminae and removing osteophytes in laminectomy
midas-rex stryker triton saber anspach
30
3 instruments for manual piecemeal removal of bone
cloward kerrison leksell rongeurs
31
Knife for incision into intervertebral space
#11 blade on a #7 handle
32
Grasp and remove fragments of herniated disc material
pituitary rongeurs
33
3 types of delicate instruments for evaluating intervertebral foramen and disc protrusion
penfield nerve hook (adson, dandy sharp or dull) dental (small or large) woodson elevator
34
3 most common complications with lumbar laminectomy
infection hemorrhage nerve root damage (paresthesia/paralysis)
35
Circle of Willis
arterial circle at base of brain in middle fossa anterior to brainstem and surrounding pituitary gland
36
Function of Circle of Willis
distribution of blood through cerebral and cerebellar hemispheres equalize BP continuity of intracranial circulation in case of arterial blockage
37
5 arteries in circle of Willis
anterior cerebral posterior cerebral middle cerebral anterior/posterior communicating
38
2 pair of arteries that supply blood to the circle of Willis
internal carotids anteriorly vertebral posteriorly
39
Aneurysm
abnormal, local dilation of an artery due to weakend tunica media
40
Most common aneurysm in cranial cavity?
saccular/berry
41
First sign of ruptured cranial aneurysm
sudden, severe headache
42
Craniotomy
incision into the skull to expose the brain (bone goes back)
43
Craniectomy
opening into the skull where bone flap isn't replaced (plate or bone cement)
44
How to preserve a free bone flap on back table until replaced?
soak in antibiotic or iodophor solution
45
4 types of scalp clips in craniectomy/craniotomy
Leroy adson raney michael
46
Why use scalp clips in craniotomy/craniectomy?
scalp bleeds profusely hemostasis
47
Special clutched burr used to create burr holes
cranial perforator (drill bit)
48
manually powered instrument to create burr holes
hudson brace
49
4 powered instruments used to create burr holes
craniotome triton anspach stryker
50
manually powered instrument to "turn" a bone flap
gigli
51
5 powered instruments using side-cutting bits to "turn" a bone flap
craniotome triton midas-rex anspach stryker
52
Instrument to initially incise dura mater
#11 blade on a #7 handle
53
4 instruments to extend the dural incision
potts-smith angulated scissors metzenbaums strully dural scissors
54
2 rigid pin-fixation devices to immobilize skull during cranial and posterior cervical surgery
gardner-wells mayfield
55
3 self-retaining brain retractors used during cranial surgery
greengerg buddle (mounted to skull clamp) leyla-yasargil (attached directly to skull)
56
2 x-ray detectable sponges for mechanical hemostasis
cottonoid patties cotton balls
57
Hemostatic agent to tamponade bleeding from cancellous bone of skull
bone wax
58
5 absorbable hemostatic aids in neurosurgery
gelfoam surgicel oxycel avitene/helistat (collagen) topical thrombin
59
3 irrigating solutions most commonly used
lactated ringers normal saline antibiotic solution
60
Sutures for dural closure
4-0 silk 4-0 braided nylon 4-0 vicryl all running stitch method
61
2 manners for securing a bone flap
plate & screw stainless steel wire
62
Most significant concern during intracranial aneurysm repair
rupture and subsequent fatal hemorrhage
63
3 drugs to decrease BP in intracranial aneurysm repair
mannitol lasix sodium nitroprusside (immediate)
64
Equipment that increases visualization in neuro
operating microscope
65
Why use bayonetted instruments?
place hand in and out of line of sight
66
Goal of intracranial aneurysm repair?
ligate the parent/feeding vessel to isolate the dilation prevent rupture
67
3 ways to treat intracranial aneurysm
temporary/permanent clips silk suture (old) methyl methacrylate impregnated gauze (old)
68
3 primary incisional approaches to repair an aneurysm in the circle of Willis
frontal bifrontal frontotemporal
69
Arteriovenous malformation
developmental anomaly of the intracranial vasculature abnormal communication between arterial and venous systems
70
Treat AVM?
isolation and excision of the mass
71
Cranioplasty?
repair a defect in the cranial wall | trauma, disease, congenital anomaly, previous surgery
72
CSF flow from primary sites of production to sites of absorption
lateral ventricles --> foramen of monro --> 3rd ventricle --> cerebral aqueduct --> 4th ventricle --> foramen of lushka/magendie --> basal cisterns of subarachnoid space --> central canal
73
Where is CSF absorbed?
arachnoid villi
74
What produces CSF?
choroid plexus + ependymal cells
75
Average volume of CSF in an adult
125-150mL
76
Normal range of intracranial pressure
70-200mm H20
77
Instrument to measure ICP
manometer
78
Hydrocephalus
pathologic condition where there is too much CSF in cranial and spinal cavaties increased ICP overproduction or insufficient absorption
79
Communicating hydrocephalus
external inadequate absorption of CSF/overproduction congenital thickening of arachnoid membrane
80
Non-communicating hydrocephalus
internal obstruction congenital malformation ductal stenosis/tumor
81
Signs & symptoms of hydrocephalus in infants and children
nausea/vomiting irritibility impaired consciousness head enlargement sunset sign
82
Diagnostics to detect hydrocephalus
CT/MRI
83
VP shunt
distal catheter to upper liver drainage absorbed by mesentery
84
VA shunt
distal catheter through jugular veins to right atrium of heart drainage absorbed into bloodstream
85
3 considerations in cephalic shunting
free of lint/glove powder soak drains in antibiotic/lactated soln assemble shunt correctly and orient
86
Ventriculoscopy
endoscopic examination of the ventricular system using a ventriculoscope
87
ESU forceps?
cushing bipolar

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