chapter 24

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duplicated, or posted to a publicly accessible website, in whole or in part.

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CHAPTER 24

Neurosurgery

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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

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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

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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

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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

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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

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

– Spinal• Basic laminectomy or neurological set • Anterior cervical discectomy • Specialty instrumentation

– Peripheral• Minor or plastic set

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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

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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

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

– C-arm and monitor– Fluid warming units and Cell Saver

autotransfusion machine  

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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

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

– Drain (HemoVac)– Nerve stimulator– Microscope drape– C-arm drape– Ultrasound wand drape– Suture material – Medications and solutions

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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

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Cranial Procedures (cont’d.)• Include:

– Craniotomy– Craniotomy for aneurysm repair surgical

anatomy and pathology– Cranioplasty – Craniosynostosis repair– Craniectomy for steriotactic procedures

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Cranial Procedures (cont’d.)– Ventriculoperitoneal shunt placement– Ventriculoscopy– Transphenoidal hypophysectomy

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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

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Spinal Procedures (cont’d.)• Include:

– Lumbar laminectomy for diskectomy with spinal fixation

– Microdecompression endoscopic spinal diskectomy

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

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Spinal Procedures (cont’d.)– Posterior cervical decompression – Anterior thoracic decompression – Rhizotomy

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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

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Peripheral Nerve Procedures (cont’d.)

• Include:– Carpal tunnel release– Ulnar nerve transposition

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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