Neurosurgery Review Questions
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Why is hemostasis particularly important during cranial surgery?
The brain requires 20% more oxygen than the other organs in the body to function adequately. Damage to or lack of oxygen to these structures could also cause damage to the nervous system.
How is excess cerebrospinal fluid surgically shunted out of the brain?
A lumber drain may be placed in the subarachnoid space before a surgical procedure to remove CSF from the spinal canal or brain; this decompresses the tissue. Ventricular shunting is also used to divert CSF from the ventricles of the brain to another location in the body, (i.e. the peritoneal cavity)
What precautions should be taken to prevent loss of or damage to the bone flap during craniotomy?
The bone flap can be folded back and secured during the procedure or removed completely. During the procedure, the scrub should provide a continuous stream of irrigation fluid over the drill tip or saw during drilling. Once removed, it should be placed in a dedicated basin and covered with antibiotic solution or normal saline. The basin is placed in a protected area of the back table and must be clearly marked so that it can be identified during the case.
Why are burr holes required to remove a bone flap?
This provides a safe method of making an incision into the cranium.
Name several specialty instrument sets that might be needed during neurosurgery.
- 1. General surgery instruments-used for soft tissue access to neurological structures
- 2. Basic neurosurgical instruments-used specifically for neuro procedures
- 3. Microsurgical instruments-used in cranial, spinal, and some peripheral nerve procedures
- 4. Power instruments-used to remove and shape bone
Neurosurgical procedures can be quite lengthy. What safety and environmental precautions are particularly important to protect the patient from injury during a long procedure?
Careful attention is paid to the positioning of the patient as well as the equipment in the OR. In patient positioning, pressure points are checked to make sure they adequately padded and respiratory clearance is maintained. With OR equipment, the setup should be in such a way that when instruments are passed there is no disruption in surgeons visual field.
The Fowler position carries a high risk of embolism. Explain why.
Air embolism can occur when air enters the vascular system through an open blood vessel, the exposed occipital muscles, or the sinuses of the brain. This is considered a surgical emergency and if occurs the surgeon needs copious irrigation and sponges to cover the open vessels which will prevent any more air from entering the wound. Locating the source of the air entry and patient being repositioned to lateral position is another action surgeon may take.
Why is subdural hematoma an emergency condition?
Hematoma causes pressure on the brain tissue, causing injury and alterations in consciousness or motor function.
What methods of hemostasis are used during cranial surgery?
By using hemostatic agents, such as topical thrombin, FloSeal, Gelfoam, Surgicel, or Helistat is used to control bleeding, as well as preventing hypothermia by heating irrigation fluids.
During laminectomy, small bits of bone are removed from the lamina in rapid succession. What is the role of the scrub during this part of the procedure?
The scrub should have 4*4 ready to clean rongeurs and collect bone pieces. These pieces should be kept in a specimen cup and labeled for later use.
In what cranial procedures might a fat graft might be needed?
Transsphenoidal hypophysectomy-in which the goal is to remove all or part of the pituitary gland. Before hypophysectomy begins he graft is obtained from patients own abdomen and used for packing material in the floor of the sella and reinforces the graft to prevent CSF leak.
Describe the supplies that might be needed for debridment of a hand after an industrial accident.
Debridment usually takes place in conjunction with the skin prep or immediately after it, in which the scrub will supply the surgeon with copious amounts of sterile saline solution, sponges, antiseptic soap, a fine scalpel, tissue forceps, and dissecting scissors.
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