Exam 20: Neurosurgery

What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp?

An important area of the brain that is critical for learning and memory is the ___,while emotion and social behavior are regulated by the .

Sara Gardiner is the perioperative nurse in the circulating role in OR 2,and is planning for her three neurosurgical procedures for the day.She is explaining the basic processes of the three procedures to the scrub person and double-scrubbed surgical technology student:(1)a VP shunt insertion(2)a reconstructive craniosynostosis for an infant with severe deformity,and (3)exploration of a severe head injury with increased intracranial pressure (ICP)to evacuate a hematoma and possible brain tissue.To give the brain room to swell in the third procedure,the bone flap may need to be sterile-wrapped and stored,for later replacement.Sara asks the student to name the appropriate surgical approach to the brain for each of the procedures.She expects the correct sequence to be:

The brainstem is located in the posterior fossa and forms the floor of the fourth ventricle.It is the site of many ascending and descending fiber tracts that allow for communication among the structures of the brain and between the brain and spinal cord.The brainstem consists of what three structures?

At each vertebral level is a pair of spinal nerves,each consisting of an anterior and a posterior root.Select the statement that represents true information about motor or sensory distribution.

Microsurgical techniques have been applied to cranial,spinal,and peripheral nerve operations.Some procedures in which microsurgery is of value are explorations of the posterior fossa,especially for tumors of the fourth ventricle or cerebellopontine angle,and removal of small acoustic neuromas,with resulting preservation of the facial nerve.Each time the surgeon must look away and then back to the surgical field,open wound time and anesthesia time are increased while the surgeon becomes reoriented to the field.A nursing action,in the scrub person role,directed toward assisting the surgeon in efficiency and expediting the microsurgical procedure would be:

A familiarity with basic neurologic assessment tools gives the nurse the ability to perform a standardized neurologic exam that can be used preoperatively to establish a baseline assessment and postoperatively to establish a return to baseline or assess postoperative neurologic stability.The Glasgow Coma Scale (GCS)is commonly used to assess patients with brain injury using three indicators of cerebral function:eye opening,verbal communication,and motor response to verbal and noxious stimuli.Within the scoring range for the GCS,the best possible score is _ and the worst possible score is __.

Gina,the perioperative circulating nurse,has prepared the OR for a craniotomy for tumor and has assembled the primary bed base attachments for the head fixation positioning system.She has verified with the surgeon and anesthesia provider that the bed attachment is properly secured before the start of patient positioning and is prepared for positioning and securing the patient's head with the skull clamp.After the skull pins are secured,Gina will step back to view the head placement and symmetry,ensuring that (select all that apply):

Interventional neuroradiology uses fluoroscopy to gain access to the intracranial circulation by way of a percutaneous transfemoral catheter.The endovascular approach to the treatment of both ruptured and unruptured cerebral aneurysms is endosaccular occlusion.This is an excellent technique for aneurysms that are complex,have a neck that is too short for clipping,or are difficult to reach via traditional craniotomy.This approach is less invasive than the traditional open craniotomy with identification and clipping of the aneurysm followed by cranial closure and extended recovery.Select the true endovascular procedure that has been designed as an alternative to its open surgical option.

Brain tumors are either malignant or benign,depending on the cell type.Primary tumors generally do not resemble the carcinomas and sarcomas found elsewhere in the body and rarely metastasize outside the CNS.Select the tumor that has been identified as an extremely rare and very malignant neoplasm.

Achieving hemostasis in delicate areas can be a challenge for the neurosurgeon.In addition to using meticulous technique to prevent bleeding,topical agents are routinely used as an adjunct to hemostasis.Some hemostatic products form a composite clot that seals a bleeding site by using a thrombin component that converts fibrinogen in the patient's blood to fibrin.Select the diad (2)of hemostatic products that provide hemostasis by topical application,essentially acting as a patch rather than a clotting factor.

Transsphenoidal hypophysectomy (TSH)is performed with the patient administered a general endotracheal anesthetic,combined with a local anesthetic.The surgical team places the patient in a semisitting position,with the head against the headrest.A transnasal or a sublabial incision can be used for rapid access to the sella turcica.Select the diad (2)of conditions that would be appropriate indications for TSH.

Tracey,the neurosurgical perioperative nurse,is the circulating nurse on a cranial procedure with a new surgical resident on his first day on the neurosurgical surgery service.She has observed and coached him carefully as he removes the patient's hair from the intended incision site with the clippers and then combs the remaining hair away from the incision,holding it back with prepping solution.When the resident asked the scrub person for methylene blue and a sterile cotton-tipped applicator on a wood stick,Tracey intervened and offered him an indigo carmine surgical skin marker.What was Tracey's rationale for not using methylene blue as a skin marker?

The most frequently occurring tumors of the spine are metastatic,and the spine is the most common site for skeletal metastasis.From what organs or disease processes do most secondary spinal tumors originate?

Brain tumors are either malignant or benign,depending on the cell type.Primary tumors generally do not resemble the carcinomas and sarcomas found elsewhere in the body and rarely metastasize outside the CNS.Both primary and metastatic tumors of the brain and its membranes are included in the term intracranial tumors.What three tumor types are the most frequently seen CNS tumors in adults?

Metastases to the spine occur most often in the thoracic spine,followed by the lumbar and cervical areas.Treatment goals for metastatic tumors of the spine are pain relief and preservation or restoration of neurologic function.Therapeutic options include radiation,surgery,or a combination of these.Select the statement that best reflects a therapeutic spinal procedure goal for a secondary metastatic tumor.

Trigeminal neuralgia is an extremely painful and debilitating condition characterized by unilateral intense pain in the ear,eye,lips,nose,scalp,forehead,teeth,or jaw.A variety of treatments,including microvascular surgical decompression,are available.Select a minimally invasive targeted therapy that has demonstrated significant success in ablation of the entry of the trigeminal nerve.

Identify the dura fold that separates the right and left cerebral hemispheres.

Most patients will have undergone diagnostic procedures before arriving in the OR.Radiologic and other diagnostic studies are of great significance to the surgical team for determining a surgical diagnosis and developing a plan for treatment.MRI is the gold standard imaging scan for the diagnosis of tumors,abscesses,tissue/ligamentous injury,and disk herniation.Which three diagnostic tests of neurologic activity can be performed before surgery and also concurrently during the procedure?

The surfaces of the hemispheres form convolutions called gyri and intervening furrows called sulci,which serve as anatomic landmarks.Two sulci of particular anatomic importance during surgery are the lateral sulcus,or sylvian fissure,which separates the temporal lobe from the frontal and parietal lobes,and the central sulcus,or fissure of Rolando,which separates the frontal lobe from the parietal lobe.The central sulcus also separates the motor cortex from the sensory cortex.Both the motor and sensory cortices are represented by a map called a homunculus that proportionately shows each body part at the area of the gyri that controls it and illustrates how the number of neurons corresponds to the degree of motor and sensory control required.Select all the true statements about sensory and motor function.