Neuro flashcards

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