Skip this Video
Download Presentation

Loading in 2 Seconds...

play fullscreen
1 / 62

Neurosurgery - PowerPoint PPT Presentation

  • Uploaded on

Neurosurgery. Outline. A & P Pathology Diagnostics/Pre-operative Testing Medications/Anesthesia Positioning/Prepping/Draping Supplies/Instrumentation/Equipment Dressings/Drains/Post-op Care

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Neurosurgery' - lane-gillespie

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
  • A & P
  • Pathology
  • Diagnostics/Pre-operative Testing
  • Medications/Anesthesia
  • Positioning/Prepping/Draping
  • Supplies/Instrumentation/Equipment
  • Dressings/Drains/Post-op Care
  • Procedures: Carpal Tunnel Release, Craniotomy, Cervical Discectomy, Lumbar Discectomy, Ventroperitoneal Shunt
nervous system
Nervous System
  • Functions:
  • Senses changes in environment
  • Interprets changes
  • Stimulates movement to respond to these changes
organization of the nervous system
Organization of the Nervous System
  • Two systems:

1. CNS Central Nervous System

  • Two major parts: Brain and Spinal Cord

2. PNS Peripheral Nervous System

  • Everything else
peripheral nervous system
Peripheral Nervous System
  • Two major parts:
  • Afferent Nervous System
  • Sensory neurons take info from PNS to CNS
  • Efferent Nervous System
  • Motor neurons take info from CNS to PNS
efferent nervous system
Efferent Nervous System
  • Motor nervous system
  • 2 parts:
  • Somatic Nervous System
  • Skeletal muscle control
  • Conscious control
  • Autonomic Nervous System
  • Cardiac muscle, smooth muscle, and glands
  • Unconscious control
  • Has 2 divisions:
  • Sympathetic Division
  • Parasympathetic Division
autonomic nervous system
Autonomic Nervous System
  • Sympathetic vs. Parasympathetic
  • Controlled by hypothalamus and medulla oblongata
  • Both are different nerves going to the same effector or target
  • Are antagonistic
  • Parasympathetic = decreased skeletal blood flow, increased organ blood flow (quietly eating)
  • Sympathetic = increased skeletal blood flow, decreased organ blood flow (eatus interruptus by a bear!) Also called fight or flight; prepares body for emergencies
spinal cord
Spinal Cord
  • Functions:
  • Info to and from the brain
  • Integration of reflexes
  • Location:
  • Begins at foramen magnum and extends to 2nd lumbar
  • About 16-18” in length
spinal cord support structures
Spinal Cord Support Structures
  • Vertebra
  • 33 total
  • 7 cervical
  • 12 thoracic
  • 5 lumbar
  • Sacrum formed by 5 fused bones
  • Coccyx formed by 4 fused bones
intervertebral disks
Intervertebral Disks
  • Separate vertebrae
  • Outer layer is tough and called the annulus fibrosis
  • Inner core is soft and called the nucleus pulposus
  • Bear stress incurred with body weight and when lifting
spinal cord support structures1
Spinal Cord Support Structures
  • Meninges
  • Between vertebra & spinal cord
  • Epidural space between vertebra and dura mater
  • Dura Mater outermost layer extends to S-2
  • Subdural space between dura mater and arachnoid
  • Arachnoid extends to S-2
  • Subarachnoid space contains CSF
  • Pia Mater adheres directly to spinal cord and extends to L-2
  • Meninges also cover brain/continuous layer/difference epidural space not present
spinal nerves
Spinal Nerves
  • 31 pair
  • Names and numbers depend on where enter and exit
  • Each has a ventral and dorsal root
  • Ventral root = motor
  • Dorsal root = sensory
  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
  • 1 coccygeal
  • Protected by the cranium or skull
  • 4 major parts:
  • Brain stem
  • Diencephalon
  • Cerebellum
  • Cerebrum

Weight about 3 lbs.

support structures of the brain
Support Structures of the Brain

1. Meninges

  • Continuous layer with spinal cord
  • NO epidural space
support structures of the brain1
Support Structures of the Brain

2. Cerebrospinal fluid (CSF)

  • About 800ml produced each day by the choroid plexus, a specialized set of capillaries
  • Circulates inside subarachnoid space through central canal of spinal cord and the ventricles of the brain
  • Reabsorbed in arachnoid villus found in the parietal lobe
  • Functions as a shock absorber and circulates nutrients
support structures of the brain2
Support Structures of the Brain
  • Blood Brain Barrier
  • Specialized set of capillaries exclusive to the central nervous system
  • Less permeable than any other capillaries in the body
  • Advantage = keeps out unwanted chemicals
  • Disadvantage = difficult to diffuse materials out, hence difficulty in treating conditions such as encephalitis
brain stem
Brain Stem
  • 3 parts:
  • Medulla oblongata
  • Pons
  • Midbrain
medulla oblongata
Medulla oblongata
  • Contains:
  • 5 of 12 cranial nerves
  • Pyramids: function only with motor neurons/a crossing of the spinal nerve impulses
  • Reflex centers: hiccupping, sneezing, coughing
  • Vital reflex centers:
  • Cardiac center – heart rate
  • Vasoconstrictor center-BP via blood vessel diameter control
  • Respiratory center - breathing
  • Above medulla
  • Switching point for motor neurons
  • Respiratory center
midbrain or mesencephalon
Midbrain or Mesencephalon
  • Above pons
  • Involuntary eye and head movement in response to auditory stimuli
  • 2 parts:
  • Thalmus
  • Hypothalmus
  • Relay center for sensory information
  • Interprets stimuli for example pain from changes in temperature (hot stove)
  • 1st level of reasoning occurs here
  • Recognizes crude touch NOT localized touch
  • Controls large number of subconscious functions
  • Controls most of Autonomic nervous system
  • Where endocrine and nervous systems interface
  • Homeostasis regulation of the body
  • Controls: body temp, thirst, hunger, sleep and waking habits, psychosomatic disorders, rage and aggression
  • 2nd largest part of the brain
  • Primarily a motor area
  • Controls skeletal muscles, subconsciously
  • Receives sensory input from eyes, muscles, joints, and inner ear
  • Posture, balance, coordination, equilibrium
  • Muscle sense tells body where other parts are
  • Largest part of brain
  • Motor/sensory/association area
  • 4 Lobes: frontal, parietal, occipital, temporal
  • Each controls a specific function be it motor or sensory
  • Limbic system: controls emotion/functions in cerebral cortex and diencephalon
  • See page 970 Figure 24-4 in Price
cerebrum lobes function

Memory, abstract thinking, ethics, judgement, emotion, expressive speech, motor


Sensory, receptive speech, written word


Auditory, olfactory


Visual cortex

Visual association

Cerebrum Lobes’ Function
cranial nerves
Cranial Nerves
  • All originate in the brain stem EXCEPT the 1st and 2nd
  • Classified as sensory or mixed (sensory and motor) nerves
  • Directly off of brain
  • Do not go through the spine
  • Identified by Roman numerals and names
cranial nerves1
Cranial Nerves
  • Olfactory - sense of smell
  • Optic – sense of sight/vision
  • Occulomotor – eyeball, eyelid movement (medial, inferior, superior rectus, inferior oblique), pupil constriction, lens accommodation

Muscle sense for eyeball

  • Trochlear – eyeball movement (superior oblique)

Muscle sense for eyeball

  • Trigeminal – masseter muscle control

Sensory part has 3 branches: ophthalmic (forehead to corner of eye), maxillary (corner of eye to upper lip/teeth), and mandibular (lower lip/teeth/tongue)

All three convey sense of touch, pain and temp changes

  • Abducens - same as IV eyeball movement (lateral rectus) and eyeball muscle sense

FYI: EOM formula LR6(SO4)3

cranial nerves2
Cranial Nerves
  • Facial- facial muscles, lacrimal and salivary glands anterior 2/3 of tongue (taste)
  • Vestibulocochlear -last of totally sensory nerves; has 2 branches: vestibular conveys balance and cochlear which conveys sense of hearing
  • Glossopharyngeal -salivary gland secretion and posterior 1/3 of tongue
  • Vagus – internal organ control motor and sensory; originates in medulla and goes down through neck into chest and abdomen
  • Accessory – controls head and neck movement, speech, and muscle sense for the head
  • Hypoglossal – tongue muscles: swallowing, speech, muscle sense for tongue
cervical spine pathology
Cervical Spine Pathology
  • Very serious
  • Can have severe consequences related to all of the spinal cords’ nerve pathways
  • Spondylosis is osteophyte or bone spur formation in the spinal canal
  • Cervical disk extrusion acute or chronic
  • Treatment errs on the side of caution due to potential extreme consequences of surgical intervention
thoracic pathology
Thoracic Pathology
  • Spondylosis
  • Extrusion of disk
lumbar pathology
Lumbar Pathology
  • Spondylosis
  • Stenosis
  • Spondylolithesis
  • Disk extrusion
neoplasms tumors
  • Two types:
  • Primary
  • Originate in nervous tissue or meninges
  • Secondary
  • Are metastasized from other parts of the body
  • May be classified as benign or malignant
  • Benign tumors:
  • “Craniopharyngiomas, epidermoids, hemangiomas, menigiomas, acoustic neuromas, and pituitary microadenomas” Price, 2004
  • Malignant tumors:
  • “Astrocytes or gliomas” Price, 2004
  • Benign usually excisable via craniotomy
  • Malignant normally cannot be completely removed but efforts are made to remove most
head trauma
Head Trauma
  • Includes;
  • Scalp lacerations, fractures, hematomas (epidural or subdural), and brain injuries
spinal cord trauma
Spinal Cord Trauma
  • Vertebral Fracture
  • Vertebral Dislocation
  • Herniated disk into spinal canal
  • Laceration from GSW or MVA
cerebrovascular disease
Cerebrovascular Disease
  • #3 cause of death in US
  • Symptoms reflect ischemia (TIAs) or hemorrhage
  • Intracranial aneurysm
  • Arteriovenous malformations
  • Brain hemorrhage
  • Stroke or cerebrovascular accident (CVA)
congenital pathology
Congenital Pathology
  • Craniosynotosis “premature closure of the

cranial sutures” Price, 2004

  • Hydrocephalus result of obstructed CSF flow
  • Spina bifida
  • Abscess
  • Subdural empyema
  • Post-op infection
spinal cord tumors
Spinal Cord Tumors
  • Intramedullary in the spinal cord
  • Intradural in dura, outside spinal cord
  • Extradural outside spinal cord Price, 2004
peripheral nerve pathology
Peripheral Nerve Pathology
  • Carpal tunnel syndrome - compression of the median nerve
  • Ulnar nerve compression – compression of ulnar nerve by the ligament of Osborne

Price, 2004

  • History and physical
  • Symptoms usually specific to area of pathology
  • Electroencephalogram (EEG)
  • X-ray
  • Myelogram
  • CAT Scan
  • MRI
  • Cerebral arteriograms
  • Lidocaine 1% with epinephrine
  • Topical hemostatic agents: gelfoam, avitene, surgicel, bone wax
  • Antibiotic irrigants
  • Topical papaverine for prevention of spasm during intracranial artery surgery
  • Methyl methacrylate with cranioplasty
  • Heparin saline irrigation again with intracranial artery surgery
  • Contrast solutions with cerebral arteriography
  • Gliadel wafers (tumor bed of glioblastoma)
  • General
  • Could be local with MAC for minor laceration suturing
Cranial Surgery

Supine primarily, with a specialty headrest and or fixation devices

Can be lateral or semi-lateral



Varies with location of access

Spinal surgery

Anterior procedures require supine

Posterior procedures require prone

  • Will require shave especially on head
  • Varies with surgeon preference: betadine, alcohol, chlorohexidine
  • Care taken NOT to get in patient’s eyes or facial orifices
  • Toweled out
  • Adhesive type drape
  • Specialty drapes: laparotomy, thyroid, craniotomy, lumbar
  • Stockinette for peripheral procedures
  • Marking pen
  • Disposable bi-polar cord
  • Monopolar pencil/bovie
  • Cottonoids/patties
  • Raney clips
  • Hemostatic clips
  • Shunt catheters, tubing, connectors
  • Cotton balls
  • Hemovac drain
  • Nerve stimulator
  • Telfa
  • Microscope drape
  • C-Arm drape
  • Ultrasound wand drape
  • Minor tray if laminectomy and craniotomy trays do not have basic instrumentation
  • Laminectomy tray
  • Craniotomy tray
  • Basic ortho tray
  • Plates and screws
  • Specialty self-retaining retractor trays: Greenburg
miscellaneous instrumentation
Miscellaneous Instrumentation
  • See pages 987-990 in PRice
  • microscope
  • Video tower
  • YAG or CO2 laser
  • Positioning equipment: Mayfield headrest, Gardner-Wells
  • Operative Ultrasound machine
  • Stereotaxis system
  • CUSA Cavitron ultrasonic aspirator
  • Bipolar and monopolar ECU
  • Nitrogen source for power equipment (saws/drills)
  • Mayfield overbed table
  • Headlight and light source
  • C-Arm and monitor
  • Cell saver
  • Fluid warming and temperature regulating equipment
dressings drains post op care
Dressings/Drains/Post-op Care
  • Dressings surgeon preference
  • Drains surgeon preference
  • Post-op care: keep field sterile until patient has left the OR
  • Careful with moving patient to avoid patient injury and hemorrhage
post operative complications
Post-operative Complications
  • Infection
  • Hemorrhage
  • Nerve damage
  • CSF leakage
  • Meningitis
  • Neurological deficits