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CHAPTER 24

CHAPTER 24. Neurosurgery. Objectives. After studying this chapter, you will be able to: Recognize the relevant anatomy and physiology of the neurological system Summarize the pathology that prompts surgical intervention of the neurological system and the related terminology

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CHAPTER 24

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  1. CHAPTER 24 Neurosurgery

  2. Objectives • After studying this chapter, you will be able to: • Recognize the relevant anatomy and physiology of the neurological system • Summarize the pathology that prompts surgical intervention of the neurological system and the related terminology • Determine any special preoperative neurological diagnostic procedures/tests

  3. Objectives (cont’d.) • Indicate the names and uses of neurosurgical instruments, supplies, and drugs • Indicate the names and uses of special equipment related to neurosurgery • Determine the intraoperative preparation of the patient undergoing a neurosurgical procedure • Summarize the surgical steps of the neurosurgical procedures

  4. Objectives (cont’d.) • Interpret the purpose and expected outcomes of the neurosurgical procedures • Recognize the immediate postoperative care and possible complications of the neurosurgical procedures • Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the neurosurgical patient

  5. Introduction to Neurological Surgery   • Characteristics of neurological surgery • One of the most sophisticated surgical specialties • Encompasses advanced surgical and imaging technology • Surgery involves the brain, spinal cord, peripheral nerves, and protective structures • Common indications include congenital defects, traumatic injury, degeneration, and cancer

  6. Instruments, Routine Equipment, and Supplies • Instruments • Cranial: refer to Figures 24-1 through 24-10 • Minor set with basic instrumentation • Basic craniotomy or neurological set • Power instrumentation • Microsurgical instruments

  7. Instruments, Routine Equipment, and Supplies (cont’d.) • Spinal • Basic laminectomy or neurological set • Anterior cervical discectomy • Specialty instrumentation • Peripheral • Minor or plastic set

  8. Instruments, Routine Equipment, and Supplies (cont’d.) • Routine equipment • Gardner-Wells or Mayfield pin fixation device • Mayfield “horseshoe” headrest • Wilson frame or Andrews table • Operating microscope • Variable magnification • Nd:YAG or CO2 laser • Operative ultrasound machine • Cavitron ultrasonic aspirator

  9. Instruments, Routine Equipment, and Supplies (cont’d.) • Heating and cooling unit and temperature monitoring devices • Bipolar and monopolar electrosurgical units • Neuroendoscope, light source, recorder, and monitor • Nitrogen source for power equipment • Mayfield overhead table • Headlight and fiberoptic  light source

  10. Instruments, Routine Equipment, and Supplies (cont’d.) • C-arm and monitor • Fluid warming units and Cell Saver autotransfusion machine  

  11. Instruments, Routine Equipment, and Supplies (cont’d.) • Routine supplies • Basic pack • Ray-Tec and laparotomy sponges • Hemostatic agents • Disposable bipolar cord • Monopolar electrosurgical pencil • Radiopaque cottonoid strips and patties • Hemostatic clips • Cotton balls

  12. Instruments, Routine Equipment, and Supplies (cont’d.) • Drain (HemoVac) • Nerve stimulator • Microscope drape • C-arm drape • Ultrasound wand drape • Suture material • Medications and solutions

  13. Cranial Procedures • There are several options available for a variety of cranial procedures • There are also a number of commonalities for these procedures • Refer to text

  14. Cranial Procedures (cont’d.) • Include: • Craniotomy • Craniotomy for aneurysm repair surgical anatomy and pathology • Cranioplasty • Craniosynostosis repair • Craniectomy for steriotactic procedures

  15. Cranial Procedures (cont’d.) • Ventriculoperitoneal shunt placement • Ventriculoscopy • Transphenoidal hypophysectomy

  16. Spinal Procedures • Performed by either a neurosurgeon or an orthopedic surgeon • Neurosurgeons are almost always involved in cervical procedures, but both intervene in lumbar procedures • There are a number of commonalities for these procedures • Refer to text

  17. Spinal Procedures (cont’d.) • Include: • Lumbar laminectomy for diskectomy with spinal fixation • Microdecompression endoscopic spinal diskectomy • Anterior cervical diskectomy and fusion (ACDF): Cloward technique

  18. Spinal Procedures (cont’d.) • Posterior cervical decompression • Anterior thoracic decompression • Rhizotomy

  19. Peripheral Nerve Procedures • Nervous system of the human body is divided into two systems • Central nervous system (CNS): brain and spinal cord • Peripheral nervous system (PNS): nerves that link the various parts of the body to the CNS • Includes cranial and spinal nerves • Trauma and various compression syndromes that affect the PNS often lead to surgery

  20. Peripheral Nerve Procedures (cont’d.) • Include: • Carpal tunnel release • Ulnar nerve transposition

  21. Summary • This chapter reviewed: • Neurological system anatomy and physiology • The pathology that prompts surgical intervention of the neurological system • Preoperative neurological diagnostic procedures and tests • Neurosurgical instruments, supplies, and drugs • Surgical steps of neurosurgical procedures

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