1. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1

2. 2 CHAPTER 24 Neurosurgery

3. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3 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

4. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 4 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

5. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 5 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

6. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 6 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

7. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 7 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

8. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 8 Instruments, Routine Equipment, and Supplies (cont’d.) –Spinal Basic laminectomy or neurological set Anterior cervical discectomy Specialty instrumentation –Peripheral Minor or plastic set

9. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 9 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 CO 2 laser –Operative ultrasound machine –Cavitron ultrasonic aspirator

10. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 10 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

11. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 11 Instruments, Routine Equipment, and Supplies (cont’d.) –C-arm and monitor –Fluid warming units and Cell Saver autotransfusion machine

12. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 12 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

13. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 13 Instruments, Routine Equipment, and Supplies (cont’d.) –Drain (HemoVac) –Nerve stimulator –Microscope drape –C-arm drape –Ultrasound wand drape –Suture material –Medications and solutions

14. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 14 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

15. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 15 Cranial Procedures (cont’d.) Include: –Craniotomy –Craniotomy for aneurysm repair surgical anatomy and pathology –Cranioplasty –Craniosynostosis repair –Craniectomy for steriotactic procedures

16. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 16 Cranial Procedures (cont’d.) –Ventriculoperitoneal shunt placement –Ventriculoscopy –Transphenoidal hypophysectomy

17. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 17 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

18. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 18 Spinal Procedures (cont’d.) Include: –Lumbar laminectomy for diskectomy with spinal fixation –Microdecompression endoscopic spinal diskectomy –Anterior cervical diskectomy and fusion (ACDF): Cloward technique

19. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 19 Spinal Procedures (cont’d.) –Posterior cervical decompression –Anterior thoracic decompression –Rhizotomy

20. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 20 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

21. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 21 Peripheral Nerve Procedures (cont’d.) Include: –Carpal tunnel release –Ulnar nerve transposition

22. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 22 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