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Questions and Answers

What is the literal translation of Spina Bifida?

  • Incomplete closure
  • Split spine (correct)
  • Broken back
  • Neural tube defect

    • What is Cranioplasty?

  • A surgical procedure to repair a spinal cord injury
  • A surgical procedure to remove a tumor from the skull
  • A surgical repair of a bone defect in the skull (correct)
  • A surgical procedure to remove a disk from the spine

    • Why should Methylene Blue not be used to mark the skin prior to Neurosurgical procedures?

  • It may cause irritation if it contacts delicate neural tissue (correct)
  • It can cause skin cancer
  • It is not a suitable dye for skin
  • It can cause an allergic reaction

    • What is the primary component of the Nucleus Pulposus?

    <p>Water</p> Signup and view all the answers

    What is a common reason for Cranioplasty?

    <p>Skull tumor removal</p> Signup and view all the answers

    What is the function of the Nucleus Pulposus?

    <p>To allow the vertebral disc to withstand forces of compression and torsion</p> Signup and view all the answers

    What is the primary cause of Spina Bifida?

    <p>Neural tube defect during embryonic development</p> Signup and view all the answers

    What is the outcome of using Methylene Blue in Neurosurgery?

    <p>Increased neuronal loss and altered membrane electrical properties</p> Signup and view all the answers

    Where do compression fractures typically occur in the spine?

    <p>In the thoracic region</p> Signup and view all the answers

    What is the primary goal of vertebroplasty?

    <p>To relieve spinal pain and restore mobility</p> Signup and view all the answers

    What is the purpose of a small clip placed across the neck of the aneurysm during surgical clipping?

    <p>To block the normal blood flow from entering the aneurysm</p> Signup and view all the answers

    What is used to guide the instruments during an SI joint procedure?

    <p>A specially designed system</p> Signup and view all the answers

    What is the primary mechanism of preventing blood flow into the aneurysm during endovascular coiling?

    <p>Packing the aneurysm with platinum coils or balloons</p> Signup and view all the answers

    What is the typical location of bleeding into the subarachnoid space?

    <p>Between the arachnoid membrane and the pia mater surrounding the brain</p> Signup and view all the answers

    How many iFuse Implants are typically used in an iFuse procedure?

    <p>Three</p> Signup and view all the answers

    What is a common symptom of sacroiliac joint dysfunction?

    <p>Pain in the lower back or spine</p> Signup and view all the answers

    What is the primary purpose of a vessel graft in artery occlusion and bypass?

    <p>To bypass the blood flow around the occluded section of artery</p> Signup and view all the answers

    What is the name of the instrument used for spinal surgery that is used to remove bone and tissue?

    <p>Kerrisons</p> Signup and view all the answers

    What is the purpose of fluoroscopy during an SI joint procedure?

    <p>To provide real-time moving images of internal structures</p> Signup and view all the answers

    What is the primary cause of most compression fractures in vertebrae?

    <p>Osteoporosis or other diseases that weaken bone</p> Signup and view all the answers

    What is a benefit of the MIS SI joint procedure compared to open surgery?

    <p>Significantly less recovery time</p> Signup and view all the answers

    What is the name of the procedure where a small clip is placed across the neck of the aneurysm?

    <p>Surgical clipping</p> Signup and view all the answers

    What is the purpose of fluoroscopy in endovascular coiling?

    <p>To guide the catheter through the bloodstream</p> Signup and view all the answers

    What is the typical number of iFuse Implants used in an iFuse procedure?

    <p>3</p> Signup and view all the answers

    What is the position of the patient during the iFuse procedure?

    <p>Prone</p> Signup and view all the answers

    What is the purpose of the C-arm during the iFuse procedure?

    <p>To mark the level and determine exact placement</p> Signup and view all the answers

    What is used to irrigate the incision after the procedure?

    <p>Saline solution</p> Signup and view all the answers

    What is a potential risk associated with the iFuse procedure?

    <p>All Of The Above</p> Signup and view all the answers

    What is used to close the incision?

    <p>2-0 Vicryl on an SH and 3-0 Monocryl</p> Signup and view all the answers

    What is the primary purpose of Motor Evoked Potentials (MEPs) in neuromonitoring?

    <p>To elicit a response from muscles and assess the integrity of motor pathways</p> Signup and view all the answers

    Which of the following procedures benefits most from neuromonitoring?

    <p>Posterior cervical and thoracic decompressions</p> Signup and view all the answers

    What is the primary advantage of Somatosensory Evoked Potentials (SSEPs) in neuromonitoring?

    <p>Excellent reliability and allows for continuous monitoring during surgery</p> Signup and view all the answers

    What is the primary limitation of Somatosensory Evoked Potentials (SSEPs) in neuromonitoring?

    <p>Detection of a signal change can be delayed by up to 16 minutes</p> Signup and view all the answers

    What is the purpose of triggered electromyography (tEMG) in neuromonitoring?

    <p>To detect muscle activity in response to stimulation</p> Signup and view all the answers

    What is the primary difference between spontaneous electromyography (sEMG) and triggered electromyography (tEMG)?

    <p>sEMG is spontaneous activity, while tEMG is stimulated activity</p> Signup and view all the answers

    Which of the following is a limitation of Somatosensory Evoked Potentials (SSEPs) in neuromonitoring?

    <p>False-negatives and false-positives have been reported</p> Signup and view all the answers

    What is the primary benefit of using multiple neuromonitoring modalities, such as MEPs and SSEPs?

    <p>Provides a more comprehensive assessment of neural function</p> Signup and view all the answers

    What is a potential risk associated with the iFuse procedure?

    <p>Local injury to the pelvis</p> Signup and view all the answers

    What is the purpose of carpal tunnel surgery?

    <p>To relieve pressure on the median nerve</p> Signup and view all the answers

    What is a potential complication of spine surgery?

    <p>Neurological injury</p> Signup and view all the answers

    What is the purpose of neuromonitoring during spine surgery?

    <p>To avoid post-surgical neurological complications</p> Signup and view all the answers

    What is the primary risk associated with the iFuse procedure?

    <p>Migration, loosening, breakage or failure of the implant</p> Signup and view all the answers

    What is the purpose of spine surgery?

    <p>To treat spine injuries or conditions</p> Signup and view all the answers

    What is the primary function of the choroid plexus in the body?

    <p>To produce cerebrospinal fluid and provide a barrier against toxins</p> Signup and view all the answers

    What is the name of the circulatory system that supplies blood to the brain and surrounding structures?

    <p>Circle of Willis</p> Signup and view all the answers

    What is a common reason for intracranial surgery?

    <p>Tumor</p> Signup and view all the answers

    What is the name of the structural defect characterized by a downward displacement of the cerebellar tonsils?

    <p>Chiari malformation</p> Signup and view all the answers

    What is the traditional microscopic approach to tumor removal?

    <p>Sub-labial incision</p> Signup and view all the answers

    What is the location of the patient during a suboccipital craniotomy?

    <p>Prone</p> Signup and view all the answers

    What is the Sella Turcica?

    <p>A region of the pituitary gland</p> Signup and view all the answers

    What is the benefit of the endoscopic technique over the traditional microscopic approach?

    <p>Reduced trauma to nasal tissues and shorter recovery time</p> Signup and view all the answers

    What is the purpose of the tissue protector in the iFuse procedure?

    <p>To protect the surrounding tissues during the procedure</p> Signup and view all the answers

    What is the typical duration of the iFuse procedure?

    <p>1 hour</p> Signup and view all the answers

    What is the purpose of the Floseal in the iFuse procedure?

    <p>To control bleeding during the procedure</p> Signup and view all the answers

    What is the primary purpose of arterial occlusion and bypass in treating aneurysms?

    <p>To bypass the blood flow around the occluded section of the artery</p> Signup and view all the answers

    What is the position of the patient during the iFuse procedure?

    <p>Prone</p> Signup and view all the answers

    What is the typical outcome of bleeding into the subarachnoid space?

    <p>Subdural hematoma</p> Signup and view all the answers

    What is the primary function of a Spinal Cord Stimulator?

    <p>To relieve pain by sending low levels of electricity directly into the spinal cord</p> Signup and view all the answers

    What is the limitation of using triggered electromyography (tEMG) during neuromonitoring?

    <p>Lower thresholds in tEMG might indicate a cortical breach</p> Signup and view all the answers

    What is the purpose of vagus nerve stimulation?

    <p>To stimulate the vagus nerve with electrical impulses</p> Signup and view all the answers

    What is the primary application of Electromyography (EMG) in neuromonitoring?

    <p>To monitor muscle response or electrical activity in response to a nerve's stimulation</p> Signup and view all the answers

    Study Notes

    Spina Bifida

    • Spina bifida is a birth defect that occurs when the neural tube of an embryo doesn't close completely before birth.
    • This can prevent the spine's bones from forming properly and can expose part of the spinal cord and nerves through an opening in the back.

    Cranioplasty

    • Cranioplasty is the surgical repair of a bone defect in the skull that's left behind after a previous operation or injury.
    • Reasons for cranioplasty include traumatic brain injury, decompressive craniectomy, skull tumor removal, skull fractures, skull bone loss, hereditary factors, and lack of skull expansion.
    • The procedure involves lifting the scalp and restoring the contour of the skull with the original skull piece or a custom contoured graft.

    Disc Anatomy

    • The nucleus pulposus is a gelatin-like center that mostly consists of water and collagen fibers.
    • It is the inner core of the vertebral disc material.
    • The elastic inner structure allows the vertebral disc to withstand forces of compression and torsion.

    Aneurysm Treatment

    • Surgical clipping involves dissecting the brain and placing a small clip across the neck of the aneurysm to block the normal blood flow from entering the aneurysm.
    • The clip is made of titanium and remains on the artery permanently.
    • Endovascular coiling involves inserting a catheter into an artery in the groin and passing it through the blood vessels to the aneurysm, then packing the aneurysm with material to prevent blood flow.
    • Artery occlusion and bypass involves completely blocking the artery that has the aneurysm and bypassing the blood flow around the occluded section of artery by inserting a vessel graft.

    Spinal Surgery

    • Common instruments used for spinal surgery include 10 blade, Bovie, Cerebellar retractors, Cobb, Currettes, Kerrisons, Bipolar, and Aquamantis.
    • Compression fractures are defined as fractures that occur because of compression of the bone in the spine.
    • They typically occur in the thoracic region or lumbar spine, and can occur in one or more vertebrae.

    Vertebroplasty and Kyphoplasty

    • Vertebroplasty is a procedure that relieves spinal pain and restores mobility by injecting a cement-like material into the vertebrae to stabilize the bone.
    • Indications for vertebroplasty include fractures from osteoporosis or disease such as cancer.

    SI JOINT Fusion

    • The procedure involves using a specially designed system to guide the instruments that prepare the bone and facilitate placement of the titanium implants across the sacroiliac joint.
    • The whole MIS SI joint procedure takes about an hour, and recovery time is significantly less than open surgery.
    • Symptoms of sacroiliac joint dysfunction can include pain in the lower back or spine, buttocks, pelvis, groin, or legs, and can affect daily activities.

    Risks and Complications

    • Risks associated with the iFUSE procedure include adverse reactions to anesthesia, hemorrhaging or bleeding, muscle and/or nerve damage, localized bruising or swelling, blood clots, wound site infections, wound dehiscence, and damage to the tissues surrounding the surgical site.

    Neuromonitoring

    • Motor Evoked Potentials (MEPs) involve transcranial motor cortex stimulation to elicit a response from muscles and assess the integrity of motor pathways.
    • Somatosensory Evoked Potentials (SSEPs) generate a stimulus either at the level of the spinal cord or at the motor cortex to monitor sensory pathways and detect any perioperative neurologic changes.
    • EMG's generate a stimulus either at the level of the spinal cord or at the motor cortex to assess muscle activity.
    • The following spinal procedures benefit most from neuromonitoring: posterior cervical and thoracic decompressions, 3 or more level ACDF, intradural spinal cord surgery, spinal deformity surgery, and complex revision surgery.

    iFuse Procedure Risks

    • Local injury to the pelvis
    • Increased pain in the sacroiliac joint or surrounding tissues and joints
    • Allergic reaction to or rejection of the implants
    • Migration, loosening, breakage or failure of the implant
    • Muscle pain due to the change in function of the SI joint
    • Stress to and fracture of the bones in the pelvis surrounding the implants
    • Need for additional surgery to remove or adjust the positioning of one or more implants

    Carpal Tunnel Surgery

    • Carpal tunnel surgery, also known as carpal tunnel release, treats carpal tunnel syndrome by cutting through the carpal ligament in the wrist to relieve pressure on the median nerve
    • Creates more space for the median nerve and tendons, which can help improve symptoms

    Spine Surgery Risks

    • Neurological injury due to the nature of complications that can occur with spine surgery
    • Intraoperative neurophysiological monitoring (IONM) is increasingly being used to avoid post-surgical neurological complications
    • The nervous system is suppressed by anesthetics, hypothermia, hypotension, and anemia

    Choroid Plexus

    • Produces cerebrospinal fluid and helps to provide a barrier that protects the brain and other central nervous system tissue from toxins

    Reasons for Intracranial Surgery

    • Tumor
    • Congenital Abnormalities (e.g. Anencephaly, Encephalocele, Hydrocephalus, Chiari malformation)
    • Trauma (most common MVA)
    • Trigeminal Neuralgia
    • Vascular Diseases (e.g. Aneurysms, Vascular malformations, Stroke/Brain Bleed or Clot evacuation)
    • Pituitary Tumors

    Circle of Willis

    • The circulatory system that supplies blood to the brain and surrounding structures
    • Comprises four arteries that feed into the system

    Hydrocephalus

    • A condition where there is an accumulation of cerebrospinal fluid in the brain, leading to increased pressure

    Chiari Malformation

    • A structural defect in the cerebellum where the cerebellar tonsils descend through the foramen magnum
    • Can cause non-communicating hydrocephalus as a result of obstruction of cerebrospinal fluid flow

    Traditional Microscopic Approach vs. Endoscopic Technique

    • Traditional microscopic approach: performed through an incision made under the upper lip (sub-labial) along with removal of the nasal septum to access the tumor
    • Endoscopic technique: a less invasive approach that reduces trauma to the nasal tissues and recovery time for the patient

    Aneurysm Treatment

    • Surgical clipping: a small clip is placed across the neck of the aneurysm to block blood flow
    • Endovascular coiling: a catheter is inserted into an artery in the groin and passed through the blood vessels to the aneurysm, where material is used to pack the aneurysm and prevent blood flow
    • Artery occlusion and bypass: the surgeon may completely block the artery that has the aneurysm, and bypass the occluded section using a vessel graft

    Compression Fracture

    • A fracture that occurs due to compression of the bone in the spine
    • Often occurs in vertebrae weakened by osteoporosis or other diseases that weaken bone, such as cancer

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