Test 2 Flashcards

Question

Cerebellum

Answer 1

* Occupies the posterior fossa * Forms the roof of the fourth ventricle * Two lateral lobes and a medial portion * **Principally concerned with balance and coordination of movement**

Answer 2

* Brain tumors are malignant or benign * Primary tumors (arise from brain tissue) do not resemble the carcinomas and sarcomas found in the body * WHO systems lists more that 120 types of brain tumors

Answer 3

* Metastatic brain tumors are much more common in adults. * Primary malignant brain tumors are the second most common cause of cancer death in children up to 15 years old. * The second most common cause of cancer death in people ages 15-34 * Most common for children– astrocytoma, medulloblastoma, ependymoma, * Most common for adults–metastatic from lung, breast, melanoma, glioblastoma multiforme, anaplastic astrocytoma, meningioma

Answer 4

* Primary Brain Tumors * Intracranial tumors originating of CNS tissue(neuroglia tumors[gliomas]) * Benign brain tumors * Intracranial tumors that originate in the skull cavity but are not derived from the brain tissue. (meninges, pituitary gland, pineal gland) * Metastatic brain tumors * Metastatic tumors start elsewhere in the body and spread to the brain.

Answer 5

* Brain cancer treatment usually involves biopsy and resection of as much tumour as possible. This is generally followed by a combination of radiotherapy, chemotherapy and glucocorticoid treatment. * Further treatment is targeted at the symptoms that are encountered. Commonly this includes anticonvulsants (for seizure activity), antinauseants (for nausea and vomiting), analgesics (for pain), dexamethasone (reduces swelling surrounding tumour and improves neurological function), seizures and heparin prevent deep vein thrombosis

Answer 6

* originate in the skull cavity but are not derived from the brain tissue. (meninges, pituitary gland, pineal gland)

Answer 7

* Include gliomas, tumors that are from neurolgial cells * Astrocytomas * **Most common of all primary tumors** * **Glioblastoma multiforme (GBM)** * occur in the cerebellum of children and the cerebrum of adults, often cystic and discrete in children and infiltrating and not well defined in adults * Oligodendroglioma * Found in the cerebral hemispheres, infiltrating * tx is usually surgery, then radiation and then chemotherapy * Ependymoma * Children, usually in or near the ventricular walls * 4th ventricular wall – metastasizes into the subarachnoid space, surgery followed by radiation, 5 year survival rate is 73% * Medulloblastoma * Fast growing, recurring tumor in young children * **Most common malignant pediatric brain tumor**

Answer 8

* Tumors of the meninges * Meningiomas, common in 40-50 & 60 Yr * Usually benign, slow growing tumor with attachment to the dura * Can be very vascular and a challenge to remove * Tumors of the cranial nerves * Benign, slow growing * Vestibular schwannomas * Tumors of the sellar region * Pituitary adenomas * Endoscopic transsphenoidal hypophysectomy

Answer 9

* The pituitary gland is located in the pituitary fossa of the sphenoid bone **(sella turcica)**, which lies directly below the optic nerve. * Enlargement of the pituitary gland causes erosion of the surrounding bone. * Symptoms include headaches, visual field defects (compression of the optic nerve), palsies of cranial nerves III, IV, and VI.

Answer 10

* Acromegaly—occurs in adulthood or after the epiphyses of the long bones have fused. Excess Growth Hormone * Gigantism—occurs before puberty and the fusion of the epiphyses plate. Excess Growth Hormone * Cushing’s Syndrome—excessive production of ACTH (adrenocorticotropin)

Answer 11

* Minimally invasive * Minimal tissue trauma * Also may need to convert to open procedure

Answer 12

* Access to the Pituitary fossa (sella tursica) * Less invasive, some patients go home the next day

Answer 13

* Four communicating cavities called ventricles that are filled with CSF * Lower medial portion of each cerebral hemisphere * Lateral ventricle (wishbone) * Each lateral ventricle has a body and three horns; frontal, occipital and temporal. * Below is the third ventricle it communicates with the lateral ventricles through the foramen of Monro and with the fourth ventricle through the aqueduct of Sylvius * Fourth ventricle is between the cerebellum and the brainstem, roof of the ventricle is the foramen of Magendie which opens into the cisterna magna. Lateral-foramina of Luschka opens into cisterns (reservoirs)

Answer 14

* Much of the CSF originates in the choroid plexuses of the ventricles * It bathes the brain and spinal cord * Helps support the weight of the brain * Acts as a cushion for the brain and spinal cord * Total average amount of CSF circulating is 150ml (adult)

Answer 15

* Lumbar puncture * Clear and colorless

Answer 16

* Noncommunicating (obstructive) * Involves an obstruction of CSF pathways * Communicating * Abnormality in CSF absorption with increased ICP * Normal-pressure * Most common in the elderly, abnormal CSF absorption * **an abnormal increase in CSF volume within any part or all of the ventricular system** * **Treatment is VP shunt (Ventriculoperitoneal Shunt)**

Answer 17

* Forms from the blood in the Choroid plexuses * Intraventricular foramen (foramen of Monro) * Flows to the third ventricle * Cerebral aqueduct (aqueduct of sylvius) * Into the fourth ventricle * Exits through two lateral aperture, one medial aperture (Luschke, megendie) * Through the cerebellomedullary cistern and down the spinal cord and over the cerebral hemispheres * Reabsorbed in the Superior arachnoid villi * \*Ventricles hold about 25ml Remaining circulates in the cranial and spinal space secreted at a rate of 450ml/24 hr. in an adult recirculated 3 times each day

Answer 18

* German bacteriologist Paul Ehrlich found that if he injected animals with blue dye that tissues through out the whole body would turn blue, except in the brain and spinal cord. * Endothelial cells form the walls of capillaries. In the brain there is a different arrangement they join up at junctions to block the passage of most things.

Answer 19

* **The Blood brain barrier (BBB) a protective mechanism within the brain’s capillaries that helps to maintain a stable environment for the brain** * It is a selective barrier allowing such substances glucose, essential amino acids, some electrolytes, O2, Co2 etc. to pass through the brain capillary system easily while inhibiting toxic substances such as certain drugs, urea, creatinine, and other blood borne metabolic wastes

Answer 20

* Oxygen, nutrients and other substances necessary * Needs for oxygen and glucose are critical * Constant flow of blood to the brain must be maintained or brain tissue will die

Answer 21

* Brain requires 20% more oxygen than any other organ to maintain a high level of metabolic activity * Brain uses oxygen in the metabolism of glucose the chief source of energy * Without out O2 survival time is very short * Cns function is compromised with out blood gloucose and unconsciousness results * **Arterial supply to the brain** * **Internal carotid arteries anteriorly** * **Vertebral arteries posteriorly** * **Circle of Willis** * **Ensures continuity of the circulation if any one of the four main channels are interrupted** * **The brainstem and cerebellum are supplied by branches of the basilar and vertebral arteries.**

Answer 22

* Main branches for distribution of blood to each hemisphere of the brain from the internal carotid arteries are the anterior and middle cerebral arteries * Anterior cerebral artery—anterior two thirds of the medial surface of hemisphere, including half of the frontal, parietal and temporal lobes * Posterior cerebral artery—originates at the basilar artery and supplies the occipital lobe and remaining half of the temporal lobe, on the inferior and medial surfaces * The cerebral veins do not parallel the arteries as in most other parts of the body * Anastomoses in the pia mater form larger cerebral veins, cross the subdural space, empty into the great dural venous sinuses

Answer 23

* Simple skull fractures * depends on the degree of brain injury, simple skull fractures can be serious if they cross major vascular channels –causing a subdural or epidural hematoma * Depressed skull fractures * require a surgical procedure to elevate the depressed bone * Open skull fractures * should be irrigated copiously and closed to prevent infection * Deformities * Craniosynostosis is most common pedi deformity seen, caused by a premature closure or lack of formation of cranial sutures, usually repaired during the first year (brain capacity triples!!)

Answer 24

* Subdural hemorrhage * Epidural hemorrhage—lacerations of the middle meningeal artery-branch of the external carotid supplies the dura mater results from a tear in an artery, (middle meningeal) located under the temporal bone. Bleeding is arterial, rapid compression of the brain occurs. More common in young because the Dura is not so firmly attached to the skull. Presents with a history of head injury and a brief period of unconsciousness, followed by lucid period (consciousness regained) followed by rapid progression to unconsciousness. Increased ICP herniation

Answer 25

* Between the Dura and the arachnoid space * Acute –symptoms seen within 24 hours of injury * Chronic—symptoms may not bee seen for several weeks

Answer 26

* **usually caused by head injury with a skull fracture. Between the bone of the skull and the Dura.**

Answer 27

* Occurs in the brain tissue * Blood often leaks into the CSF * Usually elderly persons, and alcoholics. (friable vessels) * Can occur in any lobe of the brain, most common in frontal or temporal.

Answer 28

* is characterized by a focal ischemic cerebral neurologic deficit that lasts less than 24 hours (usually less than 1-2 hours). * Equivalent to “brain angina”, temporary disturbance in focal cerebral blood flow, which reverses before infarction occurs. * The causes are same as ischemic stroke and include atherosclerotic disease of vessels and emboli. May provide warning of impending stroke. * Symptoms of stroke/TIA always are sudden in onset and focal and are usually one-sided. The most common symptom is unilateral weakness of the face and arm or leg.

Answer 29

* CVA– Stroke Remains one of the leading causes of mortality and morbidity in the US (600,000 approximately 167,000 of these die.) Acute focal neurologic deficit from an interruption of blood flow in a cerebral vessel (ischemic stroke the most common type) due to thrombi or emboli or to bleeding into the brain tissue ( hemorrhagic stroke) * Thrombolic– common sites of plaque formation include larger vessels of the brain. The origins of the internal carotid and vertebral arteries, and junctions of the basilar and vertebral arteries. These infarcts often affect the cortex, causing aphasia, hemi neglect syndrome (patients fail to be aware of items to one side of space.), visual field defects, or transient mononuclear blindness (Peripheral blindness). Seen in older persons with PAD, not associated with activity and may occur in a person at rest. * Embolic– caused by a moving blood clot that travels to the brain. (rheumatic heart disease, atrial fib. Recent MI, bacterial endocarditis) most originate from thrombus in the left heart, they also may originate in an atherosclerotic plaque in the carotid arteries. Affects the larger proximal cerebral vessels, lodging at bifurcations. Most common site is the middle cerebral artery. Sudden on set with immediate maximum deficit. * Hemorrhagic—most frequently fatal stroke is a spontaneous hemorrhage into the brain, edema, compression of the brain contents, age and hypertension. Causes aneurysm, trauma, arteriovenous malformations, drugs. Occurs suddenly usually when the person is active. Vomiting commonly occurs at the onset, and HA. Hemorrhage into the basal ganglia results in contra lateral hemiplegia, progresses rapidly to coma, death

Answer 30

* Aneurysms * Broad neck * Aneurysmal clipping * Small neck * coils * Vascular malformations * Arteriovenous malformations (AVM’s * Classified as acute or chronic, based on time intervals before the appearance of symptoms. * Acute progresses rapidly and has the highest mortality rate because of the severe secondary injuries, increased ICP Edema * Chronic usually after a head injury, but not for several weeks, and they have forgotten that they had an injury (older persons) blood seeping into subdural space is not absorbed it becomes encapsulated.

Answer 31

* May expose the carotid artery to have control in case of bleed * Clips and appliers must match

Answer 32

* Bridging vein bleed, but arterial * An abnormal connection between arteries and veins * Can need surgery; or not if stable

Answer 33

* Tic Douloureux * “Trigeminal Neuralgia” * Bell’s Palsy * Affects the 7th cranial nerve (facial nerve) * Menier’s Disease * Related to the 8th cranial nerve (vestibulocochlear nerve) * Acoustic Neuroma * A benign tumor of the 8th cranial nerve (vestibulocochlear nerve)

Answer 34

* “Trigeminal Neuralgia” * significant irritation of the 5th cranial nerve (mainly the maxillary or mandibular branch of the trigeminal nerve) results in facial tics, facial grimacing, and excruciating, stabbing pain to the side of the face; most effectively treated with anti-seizure medication; neuralgia can become progressively worse with time’ surgical release of scar or nerve tissue eliminates symptoms in severe cases. * Stabbing pain in parts of the face can occur on both sides of the face but not at the same time * 5th cranial nerve * Episodes can last for days, weeks, or months * Occurs most often in people over the age of 50 , more common in women than men * Anticonvulsant medications are used to block nerve firing * Rhizotomy – select nerve fibers are destroyed to block pain, causes some sensory loss and facial numbness * Surgeon must take great care to not injure the pons or the facial nerve When the risk of surgery is high because of other medical problems, or where the patient simply refuses surgery, the "gamma knife" procedure may be used. This is a method of irradiating the tumor, invented by Lars Leksell in 1971. This procedure avoids surgery with its attendant risks. In the past, this option was usually recommended only for higher risk surgical cases because of the possibilities of late radiation complications, and the need for ongoing MRI monitoring of the results of the procedure.

Answer 35

* Affects the 7th cranial nerve (facial nerve) * results in unilateral facial paralysis of sudden onset; cause unknown; involves swelling of the facial nerve perhaps due to an immune or viral disease; treated with corticosteroids; partial paralysis typically resolves after several months. * Causes: inflammation of the 7th cranial nerve (herpes zoster, HIV, middle ear infection) * Sometimes have a cold before the symptoms begin * Start suddenly, usually on one side of the face * Difficulty closing one eye * Drooling lack of control over the muscles * Drooping of the face * No treatment may take weeks or months for the muscles to get stronger

Answer 36

* Related to the 8th cranial nerve (vestibulocochlear nerve) * a recurrent and usually progressive group of symptoms including: ringing in the ears, dizziness, and a sensation of fullness or pressure in the ears; cause unknown but swelling of the membranous labyrinth has been found; treatment consists mainly of bed rest, antihistamines and motion sickness medication , cessation of smoking, and rarely surgery (transecting a portion of the nerve); progressive deafness can occur. * Affliction of the 8th cranial nerve, usually progressive and recurrent. * Dizziness and a sensation of fullness or pressure in the ears * Vertigo can be disabling * Can try dietary (low salt) and medications (diuretics) * When vertigo becomes intractable, can use ototoxic medications to reduce the vestibular hair cells , and also dexamethasone. * a section of the 8th cranial nerve may be removed.

Answer 37

* symptoms include hearing loss, balance disturbances, pain, headache, and tinnitus; treatment typically consists of surgical resection of the tumor (which can lead to facial paralysis along with permanent hearing loss). * Also known as vestibular schwannoma * Is the major surgical lesion of the 8th cranial nerve * Usually a benign tumor, growing from the nerve sheath at its entrance into the internal auditory meatus * Symptoms include unilateral deafness, tinnitus, unilateral impairment of cerebellar function, numbness of the face (involvement of 5th cranial nerve)

Answer 38

* Burrholes * Minimum exposure that can be made to access the brain * Craniotomy—removal of a section of the cranium “bone flap” * Craniectomy—removal of a section of the cranium –permanently * Transsphenoidal Approach—route to the pituitary fossa through the nose or gingiva

Answer 39

* After trauma decompression of the brain and removal of any hematomas that are above or beneath the dura mater may be required. * Evacuation can be done through burr holes or a craniotomy

Answer 40

* The burr or perforator bit is used on the drill of choice (TPS, Midas Rex) * Surgeon makes at least two small incisions over the site of the lesion. * If the hematoma is an epidural hematoma he will use copious amounts of irrigation to remove the clot * If the hematoma is a subdural hematoma then the dura is incised and the clot is evacuated with irrigation * A drain may be placed and if needed additional burr holes can be made as necessary

Answer 41

* Excessive accumulation of CSF and increased ICP * VP shunt

Answer 42

* The removal of a section of the cranium (bone flap) * One or more burr holes are made * Craniotome with a dura guard is used * The bone flap is replaced at the end of the procedure * Multiple types of incisions are used depending on the location of the pathology * Frontal, Parietal, occipital, Temporal or combination * Pterional is versatile approach to the anterior and middle fossae * Access frontal or temporal lobes near the Sylvian fissure

Answer 43

* Intracranial hematomas * Debulk tumors * Clip vascular lesions * Aspirate abscess * Decompress cranial nerves

Answer 44

used for positioning head in a crani

Answer 45

* May peel the scalp off the pericranium * With muscles (osteoplastic) * Or strips the periosteum off the skull before the “Flap” is turned * Flap is placed in antibiotic solution and is placed in a SAFE PLACE on table, always part of Report * May be sent to lab or placed in abdomen

Answer 46

* Permanent removal of a section of the cranium * Maybe repaired with titanium mesh

Answer 47

* Dura must always be closed- 4-0 Neurolon TF * Vicryl- 2-0 CP2 * Nylon, staples * Dressings for a head procedure may be just a wrap.

Answer 48

* Small holes in the cervical vertebrae for the vertebral artery * Protection for the spinal cord and spinal nerves * Attachments for ligaments tendons muscles * Structural support for head shoulders chest, connects upper and lower body, balance and weight distribution * Flexibility and mobility flexion extension side bending rotation * Bone produce rbc’s

Answer 49

* The vertebral column was designed to provide bony protection for the spinal cord and the 31 pair of spinal nerves coming off of the spinal cord. * **There are:** * **7 cervical vertebrae** * **12 thoracic vertebrae** * **5 lumbar vertebrae** * **5 fused sacral vertebra** * **1 coccyx (tailbone)**

Answer 50

* We begin with Kyphosis in the womb a C shape, then as we grow and muscles develop we begin walking. As we walk weight shifts to the spine and secondary curves develop in the cervical and lumbar regions * These curves are important to balance, stress absorption and distribution. * **Cervical is Lordosis** * **Thoracic is kyphosis** * **Lumbar is lordisis** * **Sacral is kyphosis** * **tailbone**

Answer 51

* The cervical spine is divided into two parts, the upper region (C-1 and C-2)and the lower (C-3 through C-7) * C-1 is also called the Atlas * First cervical vertebra supports the skull; the atlas is a ring of bone made up of two lateral masses joined at the front by the anterior arch, and at the back by the posterior arch * C-2 is called the Axis * The axis is the second cervical vertebra. It is a blunt tooth-like process that projects upward. This provides a type of pivot and collar allowing the head and atlas to rotate around the axis

Answer 52

* The thoracic vertebrae increase in size from T1 through T12. They are characterized by small pedicles, long spinous processes, and large intervertebral foramen (neural passageway) which results in less incidence of nerve compression.

Answer 53

* The lumbar vertebrae graduate in size from L1 through L5. These vertebrae bear much of the body’s weight and related stress. * The pedicles are longer and wider than the thoracic spine. The spinous processes are horizontal and more squared in shape. * The intervertebral foramen are large but nerve root compression is more common than in the thoracic spine.

Answer 54

* Largest part of the vertebra. Oval shape, covered with strong cortical bone, with cancellous bone within.

Answer 55

* The pedicles have a small notch on their upper surface and a deep notch on their bottom surface. When the vertebrae are stacked on top of each other the pedicle notches form an area called the intervertebral foramen. Nerve roots exit from the spinal cord through this area to the rest of the body

Answer 56

* Serve as connection points for ligaments and tendons

Answer 57

* Two flat plates of bone that extend from the pedicles on either side and join in the midline

Answer 58

* Two short processes, made of strong cortical bone, that protrude from the back of the vertebral body

Answer 59

* Between each vertebral body is a cushion called disc these absorb the stress and shock. * Annulus fibrosis—tire like structure that encases a gel like center called the Nucleus Pulposus

Answer 60

* help to provide structural stablity. * Intrasegmental holds individual vertebrae together * Intersegmental holds many vertebrae together

Answer 61

* with the same three meninges as the brain: * dura mater * Arachnoid mater * pia mater

Answer 62

* At each vertebral level is a pair of spinal nerves, each has an anterior and posterior root. * The anterior root (Motor root) contains cells the lie in the anterior horn of the spinal gray matter. * The posterior root (Sensory root) contain cells that lie in the spinal ganglia located in the intervertebral foramina. * After passing through the intervertebral foramen, a spinal nerve divides into several branches. * These branches are know as rami. * The ventral rami of spinal nerves form networks on both left and right sides of the body by joining with varying numbers of fibers from ventral rami of adjacent verves. * This network is called a plexus. There are four plexus.

Answer 63

* The arterial blood supply to the spinal cord arises from the vertebral arteries and the anterior spinal artery and the posterior spinal arteries * They branch and anastomose on both sides of the cord and within the cord

Answer 64

* Correct congenital malformations * Treat injuries * Remove tumors * Repair and remove herniated and degenerative disc * Drain abscesses * Treat intractable pain

Answer 65

* Spine and spinal cord tumor * Mostly metastatic * Extradural * Intradural * Extramedullary * intramedullary * Spinal epidural abscess--from infection surgery. I & D with 4-8 weeks of IV Antibiotics therapy * Disk disease-- most frequently encountered problem L4-L5, L5-S1 level is most common site. * Intractable pain * controlled by epidural opiates, patches, or medication pump, --posterior rhizotomy– asectioning the sensory roots or anterolateral cordotomy– incising the spinothalamic tracts that carry pain and temperature impulses also placement of electrodes in the epidural space. Laminectomy is necessaty for these

Answer 66

* congenital failure of the union of the vertebral arches during fetal development which often produces fluid-filled, thin-walled sacs that protrude from the fetus back * **Meningocele: dural sac filled with CSF found outside the body of the fetus** * **Myelomeningocele: dural sac filled with CSF and spinal cord found outside the body of the fetus.** * Causes—second most common birth defect, 1-out of every 1000. can occur anywhere along the spine * Can be caused by medication (antiseizure) folic acid?? * Often diagnosed prenatally and is often seen with other CNS abnormalities, hydrocephalus, Chiari malformation of the hindbrain. * Outcome depends on the type and the location.

Answer 67

1. the annulus fibrosis is often torn, but the nucleus has not extruded. 2. nucleus material forces through the tear and the posterior longitudinal ligament is stretched, but the nucleus extrusion has not yet reached the nerve. 3. The nucleus bulge protrudes further out and reaches the nerve which has to stretch over the growing bulk of the nucleus, this causes severe pain.

Answer 68

* most common problems that result in surgery. * Spondylolisthesis is the forward slipping of one vertebra over the segment below it is usually L5 over S1 * Five classes 1. dispastic-dysplasia of the posterior articulations. 2. isthmic-stress fracture of the pars interarticularis. 3. traumatic 4. degenerative 5. pathological-local disease attenuates pedicule or pars.

Answer 69

* Spondylolisthesis—forward subluxation of the lower lumbar vertebra on the sacrum * Spondylolysis—breakdown of a vertebral structure (usually due to osteoporosis) * Spondylosis—vertebral ankylosis (abnormal fixation, immobility, or fusion of a vertebral joint) * \*\*\*Treatment for these injuries include pedicle screws, intervertebral fusions and rodding between the vertebrae

Answer 70

* Both children and adults can have scoliosis. Pediatric scoliosis or spinal deformity can be due to congenital abnormalities, neuromuscular diseases, or idiopathic causes. * Congenital scoliosis can be secondary to failure of the embryonic spine to develop normally. * Neuromuscular diseases such as polio, cerebral palsy, spin bifida, and muscular dystrophy are often associated with scoliosis. * Idopathic scoliosis, as its name implies has no known cause. Subdivided into infant scoliosis 0-3 months, juvenile scoliosis 3-10 years, and adolescent scoliosis 10 years and up.

Answer 71

* Anterior cervical decompression and fusion * Treat disc herniation * Spondylosis (degeneration) * Pain in the neck, arms, hands, shoulders and weakness * Performed to treat cervical disk herniation or cervical spondylosis * Bone grafts used can be autograft or allograft. * Awake intubation may be required if neck is unstable * Supine with arms tucked, shoulder roll. * Awake intubation if unstable * Cervical injuries—placed in skeletal traction using using tongs applied to the skull. Can come to surgery with this on, great care is taken when moving and anesthesia may need to do an awake intubation. * DDD is generally the cause of most cervical problems that involve surgery. When the disc height is reduced the foramen where the nerve exits is usually narrowed. This causes irritation to the nerve and is fixed by opening the foramen when the disc is removed. * Spondylolisthesis can occur in the cervical spine, but trauma is usually the main cause.

Answer 72

* Removal of one or more of the vertebral laminae * Done in the prone position (or lateral)

Answer 73

* This procedure’s goal is to achieve bony fusion between two or more vertebral bodies. By laying bone between the transverse processes and the facet joints the fusion can take place. This procedure is often done with a laminectomy or discectomy. * The surgeon may or may not use screws to fixtate the segments. * Many surgeons use some type of fixation to account for the instability created with the laminectomy or disruption of the ligament and muscular structures

Answer 74

* Used to treat intractable pain * Generates an electrical impulse to the epidural space * Masks the pain by producing a tingling sensation

Answer 75

* X-rays—intraoperatively to verify * CT scan—with or without contrast * Standard for evaluation of acute head injury, first line screening * MRI—radiofrequency pulses in a powerful magnetic field that gives high resolution images of the body with no known risk to patients and no radiation * Is Gold standard for diagnosis of tumors, abscesses, injury and herniation

Answer 76

* Patient neurologic assessment * Preparation for surgery * Communication!!! * Patient blood * Diagnosis x-ray, neuromonitoring * Surgical procedure * Labs and diagnostic studies * Surgical approach and position * Special equipment, instruments, supplies

Answer 77

* Or bed—attachments positioning devices * Jackson table, Andrews table, Wilson frame * Skull clamps, pins, tongs * Basic equipment— phelen table. Mayos, backtables * SCD, ESU’s, bipolar, nitrogen, 2 suctions, cell saver, * Microscope— * Balanced, correct scope drape, cameras

Answer 78

* Microneurosurgery * Use of the microscope restricts the surgeon’s field of vision and mobility

Answer 79

* Endoscopes—minimally invasive surgery * X-ray, fluoroscopy c-arm or o-arm * Sterotactic and image-guided—computer and instruments * optical tracking device handheld device 3-d on screen while the surgeon is working * Ultrasonic aspirator—CUSA * Intraoperative monitoring—doppler, eeg

Answer 80

* Craniotomy set * Laminectomy set * Extra rep instruments, screws plates, cages * Retractor sets * Power instruments * Microneuro-surgical instruments * Transsphenoidal set, ENT set, Aneurysm set and clips, endoscopic equipment, CV set

Answer 81

* Scalp clips * ESU, Monopolar * Irrigation, suction (never suction a nerve!!!) * Bone wax * Cottonoids * Gelfoam * Thrombin * Surgicel, fibrillar

Answer 82

* Anesthesia must communicate with Surgeon about the procedure, position, and Most Important the \* Patient!! * IV, Central line, Arterial line, * Drugs- antibiotics, steroids, diuretics

Answer 83

* EEG—view and record electrical activity * EP—invoked potiental—response to visual auditory and sensory stimuli * SSEPS—somatosensory evoked potentials, change can indicate surgical invasion of the site * Lumbar and ventricular drains—allow for monitoring of ICP

Answer 84

* For spinal surgery * Foley catheters for monitoring urine

Answer 85

* Check with surgeon for correct position! * Equipment * Bed * Sitting (Fowler’s)—air embolism * Prone—always have the bed or stretcher available

Answer 86

* Can be complex * Towels may be sutured on, staples or may use blue impervious or 1010’s * Three quarter drapes * Equipment drapes (scope, c-arm etc..

Answer 87

RANIEY SCALP CLIP APPLIER | (bleeding control for edge of scalp)

Answer 88

RAINEY SCALP CLIPS

Answer 89

Automatic scalp clip applier

Answer 90

Aneurysm clip applier and clips (open aneurysm repair, make sure these match)

Answer 91

strully scissors

Answer 92

Dural Scissors

Answer 93

Bipolar forceps

Answer 94

adson cranial rongeur

Answer 95

Leksell rongeur

Answer 96

Smith peterson rongeur | (double action)

Answer 97

Kerrison Rongeur

Answer 98

Pituitary rongeur

Answer 99

Spurling | (type of pituitary)

Answer 100

Peapod pituitary

Answer 101

#1 Penfield | (cup)

Answer 102

#2 Penfield | (little currette)

Answer 103

#3 Penfield (looks like 2 but is really curved on disecting end)

Answer 104

Penfield 4 | (handle)

Answer 105

Penfield 5

Answer 106

Roton Micro Dissectors

Answer 107

Ball-ended dissector

Answer 108

Cobb Elevator

Answer 109

Langenbeck Elevator

Answer 110

Adson Elevator

Answer 111

Key elevator

Answer 112

Freer Elevator

Answer 113

Crile elevator | (woodson)

Answer 114

Woodson Elevator

Answer 115

Cobb Curette

Answer 116

Ring Currette

Answer 117

Epstein Curettes

Answer 118

Hudson Drill

Answer 119

Micro dissecting scissors

Answer 120

Dandy Clamp

Answer 121

Cup forceps tumor forceps

Answer 122

Bayonet forcep

Answer 123

Brain Spatula

Answer 124

Nerve Hook Sharp

Answer 125

Taylor Nerve Hook

Answer 126

Love Nerve Root Retractor

Answer 127

* D'errico nerve root retractor

Answer 128

Adson- Beckman Retractor

Answer 129

Cerebellar Retractor

Answer 130

Greenberg Retractor

Answer 131

Meyerding Retractor

Answer 132

Scoville Retractor

Answer 133

Markham myerding retractor

Answer 134

Cervical retractor

Answer 135

Cervical distractor

Answer 136

Cloward hand held retractor

Answer 137

Myerding hand held retractor

Answer 138

Taylor retractor have to anchor with tying gauze

Answer 139

Hibbs Retractor

Answer 140

Stille bone cutter

Answer 141

Horsley Bone Cutter

Answer 142

Stryker TPS

Answer 143

Midas Rex System

Answer 144

Wilson Frame | (put on Jackson table)

Answer 145

semi- fowlers, fowlers Captains Chair worry about air embolism

Answer 146

Mayfield head frame

Answer 147

Phelan Table

Answer 148

Cavitron Ultrasonic Suction Aspirator

Test 2 Flashcards

(179 cards)