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Surg. Neurosurgery
Neurosurgery
| Question | Answer |
|---|---|
| Function of the frontal lobe | Higher intellectual functions; consciousness; responses to outside stimuli, personality, motor coordination for swallowing, salivation, vocalization, chewing, facial expression, hand, arm, torso, pelvis, leg, foot |
| Functions of the parietal lobe | Visual and Touch sensations; coordinates input from different senses for understanding sensory control of the body; Writing, Mathematics and Language; controls body positioning; drawing ability; handling of objects; verbal and non-verbal memory |
| Functions of the L temporal lobe | L: Hearing, understanding, memory of what is seen or heard, recognizing words, personality, behavior, and sexual behavior. |
| Functions of the R temporal lobe | R: hearing, understanding, organizing, and concentrating on what is seen or heard, recognition of musical tones, music sound and non-speech information (drawings), LTM, personality, behavior, and sexual behavior. |
| Functions of the occipital lobe | Seeing: Interpreting what is seen and actual visual images, recognizing an object is moving, reading and writing, finding objects, identifying colors. |
| Functions of the ventricles | CSF fluid production (in the ependymal cells) and cushion for the brain |
| If you think there might be ICP, do a | CT to check |
| Communicating Hydrocephalus | Look up |
| How do you classify the location of the tumor? | Tentorium is the most important divider in the cranium. Supra or infra tentorial tumor. Diff tx, sx |
| Which tumors are likely to cause seizure | supratentorial; pre-op and post-op for these patients include antisesizure meds. Not infratentorial |
| What percentage of brain tumors are diagnosed with seizure? | 60%. One of the classic presentations for a supratentorial tumor |
| Tumors involving the ventricles or basal ganglia affect | movement. |
| Pituitary tumors present with | endocrine abnormalities or vision impairment |
| 2/3 of intracranial tumors occurring under the age of 15 are | infratentorial masses |
| Unlikely for Brain tumors to migrate outside of CNS b/c of | BBB |
| Which cancers are likely to have mets to the brain? | lung and renal cancer (sooner than breast, colon, and melanoma). In men: Lung, colon, and renal cancers account for 80% of metastatic braintumors, In women: Breast, lung, and melanoma account for 80% of metastatic braintumors |
| Study of choice for brain tumor | MRI |
| CT is good for | hydrocephalus, hemorrhage, fractures. Not great at brain tissue |
| After MRI of brain tumor, next step is | to do a PAN CT of the chest/abdomen/pelvis to rule out other lesions |
| After PAN CT, next step is | Biopsy vs resection. Then radiation and or chemotherapy. Follow up with surveillance scans: MRI, PET, CT |
| How can awake craniotomies be performed? | Brain has no nociceptors |
| When are awake craniotomies performed? | Only when the tumor is in a speech or motor area |
| Worst brain tumor you can get | GBM (Glioblastoma multiforme) |
| Single most effective therapy for many tumors | radiation |
| patient can only be considered for surgery if | they have already failed polypharmacy (2 meds). Also, don't want to remove their dominant lobe and have them come out not talking (use other adjunctive therapies) |
| To reduce risk of damaging language and memory, patients can undergo a | WADA test. determines dominant lobe |
| Right vagus nerve has a branch that supplies the | SA node. So, "pacemaker" sends electrical current every 5 minutes up the Left vagus nerve to help reduce seizures |
| In functional Neurosurgery | patients are pulled off their meds (ex: off all parkinson's meds). Given electrical stimulus until tremor stops. Patient is awake the whole time. |
| Components of functional neurosurgery | An electrode is placed at the target in brain, and is connected to a pacemaker-like device implanted in the chest wall, as shown in this picture. |
| Linear, non-displaced skull fx tx: | leave it alone |
| If depressed skull fx | tx b/c it will damage brain tissue |
| Diastatic fx | linear fracture along suture |
| Tx of Epidural hematoma | Level 1 - needs to go to OR immediately. 90%: arterial bleed - meningeal artery. Lucid interval in 50% |
| Subdural hematoma tx | usually wait. if neurologically intact, you don't have to evacuate the hematoma. If asx, wait for 14 days, and then suck out the blood like a gel. |
| Subarachnoid hemorrhages are often associated with | aneurysms. |
| Classifications used for subarachnoid hemorrhage | Fisher grade: where the blood is located; Hunt Hess tells you the patients symptoms. Higher the number, the poorer the prognosis. |
| Tx approach in an non-actively bleeding subarachnoid hemorrhage: | Triple H therapy. HTN, hypervolemia, and heme dilution (want to perfuse the brain b/c you get vasospasm, and want to prevent stroke) |
| Diffuse axon injury occurs due to | shear strain forces. Grey-white matter twists on itself. Not surgical tx, medical management instead. Poor prognosis |
| Tx of myelomeningocele | Level 1- immediate to OR. Usually caused by folic acid deficiency in the mom's diet. |
| Surgical management of subdural hematoma with a drill burr (?) | do it in the chronic phase |
| Spina Bifida cystica | can actually see the spinal cord outside of the body. Immediately go to OR. |
| Myelomeningocele are associated with | hydrocephalus |
| How to treat hydrocephalus | shunt. 1 shunt if communicating; 2 shunts if noncommunicating |
| Types of shunts | ventriculoperitoneal shunt, ventriculatrial shunt, lumboperitoneal shunt |
| Shunt integrity | tested with shunt flow study. radiotracer injected and followed with CT (?) |
| Sx of Tethered cord | Common signs and symptoms include, scoliosis, gait disturbances, motor and sensory deficits, bladder and bowel dysfunction. TX: remove tether; surgery is Tx of choice |
| If pt has more than one lesion in the brain | chemo/radiation. Need to know pathology, where are these tumors from? If one causes a specific dysfunction, that one can be removed. |
| Lateral tumors involving the Basal Ganglia include | Parkinsonism with cogwheel rigidity and a paucity of movement (akinesia) |
| 2/3 of intracranial tumors occurring under the age of 15 are located | below the tentorium (infratentorial masses) |
| Secondary Metastatic Brain tumors are often from the following primary locations: | Lung and renal cancer. These two spread sooner than breast, colon or melanoma. |
| Study of choice to dx a brain tumor | MRI. Then f/u with pan CT of Chest/Abdomen/Pelvis. Biopsy vs resection to confirm pathology |
| In a temporal lobectomy for the treatment of intractable epilepsy, what procedure/test is performed to reduce the risk of damaging language and memory? | the WADA test which temporarily "paralyzes" that half of the brain into which it is injected; patients are shown flashcards, and stop talking or remembering when the sodium amytal (paralysis)sets in, so the area involved w/language or memory is identified |
| Hemorrhage into the CSF space | Subarachnoid hemorrhage. 80% caused by trauma. Non-traumatic causes: aneurysm, AVM, coagulopathy-->coumadin |
| Shape of an epidural hematoma | Biconvex, lenticular, limited by sutures. Lucid interval occurs in 50% of people. 90% of the time it is d/t arterial bleed (meningeal artery) |
| Subdural hematoma | crosses sutures, crescentic shaped. associated with underlying brain injury |
| Synostosis of the ___________ suture produces a triangular shape of the head | metopic (normally begins closure at age 2) |
| Most common craniosynostosis syndrom | Crouzon (skull and facial deformity plus exopthalmos), Apert is second most common (Presents with very highbrachycephalic head and severe syndactyly affecting all limbs.) |
| Most common causes of hydrocephalus (HCP) | post meningitis and post hemorrhage (Other causes include, myelomeningocele, Choroid plexus papiloma, Chiari malformation, Aqueductal stenosis, Tumors) |
| Signs and sx of hydrocephalus | Cranium enlarges > than facial growthIrritability, N, V, poor head controlEnlarged and bulging fontanelleUpward gaze palsyHyperactive reflexesIrregular respirations with apneic spellsBradycardia |
| Normal terminating location of the conus medularis | L1 and L2. Tethered cord is an abdnormally low conus medularis (Common signs and symptoms include, scoliosis, gait disturbances, motor and sensory deficits, bladder and bowel dysfunction) |
Created by:
ltm12