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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

CHAPTER 24

Neurosurgery


Objectives
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


Objectives cont d
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


Objectives cont d1
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


Introduction to neurological surgery
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


Instruments routine equipment and supplies
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


Instruments routine equipment and supplies cont d
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Spinal

    • Basic laminectomy or neurological set

    • Anterior cervical discectomy

    • Specialty instrumentation

  • Peripheral

    • Minor or plastic set


Instruments routine equipment and supplies cont d1
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


Instruments routine equipment and supplies cont d2
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


Instruments routine equipment and supplies cont d3
Instruments, Routine Equipment, and Supplies (cont’d.)

  • C-arm and monitor

  • Fluid warming units and Cell Saver autotransfusion machine  


Instruments routine equipment and supplies cont d4
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


Instruments routine equipment and supplies cont d5
Instruments, Routine Equipment, and Supplies (cont’d.)

  • Drain (HemoVac)

  • Nerve stimulator

  • Microscope drape

  • C-arm drape

  • Ultrasound wand drape

  • Suture material

  • Medications and solutions


Cranial procedures
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


Cranial procedures cont d
Cranial Procedures (cont’d.)

  • Include:

    • Craniotomy

    • Craniotomy for aneurysm repair surgical anatomy and pathology

    • Cranioplasty

    • Craniosynostosis repair

    • Craniectomy for steriotactic procedures


Cranial procedures cont d1
Cranial Procedures (cont’d.)

  • Ventriculoperitoneal shunt placement

  • Ventriculoscopy

  • Transphenoidal hypophysectomy


Spinal procedures
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


Spinal procedures cont d
Spinal Procedures (cont’d.)

  • Include:

    • Lumbar laminectomy for diskectomy with spinal fixation

    • Microdecompression endoscopic spinal diskectomy

    • Anterior cervical diskectomy and fusion (ACDF): Cloward technique


Spinal procedures cont d1
Spinal Procedures (cont’d.)

  • Posterior cervical decompression

  • Anterior thoracic decompression

  • Rhizotomy


Peripheral nerve procedures
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


Peripheral nerve procedures cont d
Peripheral Nerve Procedures (cont’d.)

  • Include:

    • Carpal tunnel release

    • Ulnar nerve transposition


Summary
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