Neurosurgery Outlines (eBook)

Paul Kaloostian (Autor)

eBook Download: EPUB

2020 | 1. Auflage
348 Seiten
Georg Thieme Verlag KG
978-1-63853-673-4 (ISBN)

Infos

<p><strong><em>Pocket-size, user-friendly roadmap outlines most common surgical procedures in neurosurgery!</em></strong></p> <p>Surgery requires a combination of knowledge and skill acquired through years of direct observation, mentorship, and practice. The learning curve can be steep, frustrating, and intimidating for many medical students and junior residents. Too often, books and texts that attempt to translate the art of surgery are far too comprehensive for this audience and counterproductive to learning important basic skills to succeed. <cite>Neurosurgery Outlines</cite> by neurosurgeon Paul E. Kaloostian is the neuro-surgical volume in the <cite>Surgical Outlines</cite> series of textbooks that offer a simplified roadmap to surgery.</p> <p>This unique resource outlines key steps for common surgeries, laying a solid foundation of basic knowledge from which trainees can easily build and expand. The text serves as a starting point for learning neurosurgical techniques, with room for adding notes, details, and pearls collected during the journey. The chapters are systematically organized and formatted by subspecialty, encompassing spine, radiosurgery, brain tumors and vascular lesions, head trauma, functional neurosurgery, epilepsy, pain, and hydrocephalus. Each chapter includes symptoms and signs, surgical pathology, diagnostic modalities, differential diagnosis, treatment options, indications for surgical intervention, step-by-step procedures, pitfalls, prognosis, and references where applicable.</p> <p><strong>Key Features</strong></p> <ul> <li>Provides quick procedural outlines essential for understanding procedures and assisting attending neurosurgeons during rounds</li> <li>Spine procedures organized by cervical, thoracic, lumbar, sacral, and coccyx regions cover traumatic, elective, and tumor/vascular-related interventions</li> <li>Cranial topics include lesion resection for brain tumors and cerebrovascular disease and TBI treatment</li> </ul> <p>This is an ideal, easy-to-read resource for medical students and junior residents to utilize during the one-month neurosurgery rotations and for quick consultation during the early years of neurosurgical practice. It will also benefit operating room nurses who need a quick guide on core neurosurgical procedures.</p> <p>This book includes complimentary access to a digital copy on <a href='https://medone.thieme.com/'>https://medone.thieme.com.</a></p>

Textauszug

1 Cervical

Christ Ordookhanian and Paul E. Kaloostian

1.1 Trauma

1.1.1 Anterior Cervical Fusion/Posterior Cervical Fusion

Indications

• Traumatic occipitoatlantal disjointment

• No complete arch of C1

• Bursting C1 fracture (see ▶Fig. 1.1)

• Congenital abnormalities

• Odontoid movement into foramen magnum

• Vertebral shifts

Symptoms and Signs

• Stiff neck

• Sharp pinpoint pain in neck

• Soreness lasting >7 days

• Weakness in neck muscle

• Tingling/Numbness in general neck area

• Trouble gripping objects

• Tingling in finger tips

• Frequent tension headaches (~4+ days per week)

Surgical Pathology

• Traumatic brain injury (TBI)

• Traumatic injury to general neck region

– Fracture/Displacement/Compression

Surgical Procedure

1. Informed consent signed, preoperative labs normal, no Aspirin/Plavix/Coumadin/other anticoagulants for at least 12 days

2. Appropriate intubation and sedation

3. Horizontal skin incision 1 to 2 inches on either side of the spine

4. Split thin muscle underlying skin

Fig. 1.1 (a–c) A man suffered an incomplete cord injury after a vehicle crash. Radiology revealed that his cervical trauma was a C5 complete burst fracture. (Source: Diagnostic Features. In: Vialle L, ed. AOSpine Masters Series, Volume 5: Cervical Spine Trauma. 1st ed. Thieme; 2015).

5. Enter plane between sternocleidomastoid muscle and strap muscle

6. (Anterior) Enter into the plane between trachea/esophagus and carotid sheath

7. Dissect away thin fascia

8. Locate disk (preoperative imaging match/intraoperative fluoroscopy)

9. Remove disk by cutting annulus fibrosis and nucleus pulposus

10. Remove entire disk including cartilage endplates to reveal cortical bone

11. Remove ligamentous tissue front to back to allow access to spinal canal

12. Insert bone graft and implant cage into evacuated space

13. Attach small plate to front of spine with screws in each vertebral bone (see ▶Fig. 1.2 to ▶Fig. 1.4)

14. Clean surgical site, exit, and suture

15. If posterior approach is needed, place the patient prone with Mayfield head pins with all pressure points padded

16. Dissect to lamina over affected levels and confirm levels on X-ray

17. Perform laminectomy and foraminotomies over affected levels that are stenotic and place lateral mass screws with rods and bone graft if needed over affected levels for fusion

18. Obtain hemostasis, place drain, and close wound in multiple layers

Pitfalls

• Loss of neck mobility by ~30%

• Intraoperative cerebrospinal fluid (CSF) leak

Fig. 1.2 (a, b) Cord decompression, corpectomy (C5), and fusion (C4–C6) were performed. The fusion healed within one year. (Source: Diagnostic Features. In: Vialle L, ed. AOSpine Masters Series, Volume 5: Cervical Spine Trauma. 1st ed. Thieme; 2015).

Fig. 1.3 (a–d) A patient suffered cervical trauma resulting in C3/C4 dislocation. Fusion (C3–C4) was performed and lateral mass screw placement was verified using X-ray and CT scan. (Source: Cervical case studies. In: Perez-Cruet M, Fessler R, Wang M, eds. An Anatomic Approach to Minimally Invasive Spine Surgery. 2nd ed. Thieme; 2018).

• Blood clot (deep vein thrombosis, or more severe pulmonary embolism)

• Damage to spinal nerves and/or cord

• Postoperative weakness or numbness or continued pain

• Postoperative wound infection

• Continued symptoms postsurgically/unresolved symptoms with no improvement to quality of life

Fig. 1.4 A man suffered cervical trauma after a bicycle accident, resulting in traumatic disk herniation. Radiology revealed associated cord contusion and C3–C4 instability. Fusion (C3–C4) was performed and after therapy, his paresis reduced. (Source: Brembilla C, Lanterna L, Gritti P, et al. The use of a stand-alone interbody fusion cage in subaxial cervical spine trauma: a preliminary report. J Neurol Surg A Cent Eur Neurosurg 2015;76(01):13–19).

Prognosis

• Most patient are hospitalized for 1 to 2 days, then return home with strict orders of minimal sudden head/neck movement

• Typically, 4 to 6 weeks post operation most patients are able to return to normal day-to-day activities

• Full fusion (formation of hard bone) may take 12 to 18 months

• Physical therapy (PT) and occupational therapy (OT) should strongly be considered

1.2 Elective

1.2.1 Anterior Cervical Fusion/Posterior Cervical Fusion

Indications

• No complete arch of C1

• Bursting C1 fracture

• Congenital abnormalities

• Odontoid movement into foramen magnum

• Vertebral shifts

Symptoms and Signs

• Stiff neck

• Sharp pinpoint pain in neck

• Soreness lasting >7 days

• Weakness in neck muscle

• Tingling/Numbness in general neck area

• Trouble gripping objects

• Tingling in finger tips

• Frequent tension headaches (~4+ days per week)

Surgical Pathology

• Spondylosis

• Spondylosis

• Adjacent segment pathology (ASP)

• Radiculopathy (see ▶Fig. 1.5)

• Osteomyelitis

• Vertebral body tumors

• Myelopathy (see ▶Fig. 1.6 and ▶Fig. 1.7)

• Postlaminectomy kyphosis (see ▶Fig. 1.8)

• Opacified posterior longitudinal ligament

Fig. 1.5 (a, b) An elderly woman with neck pain and deformity from myelopathy received posterior decompression (C3–C6), anterior diskectomy and fusion (C4–C5), and posterior fusion (C2–T2). A transition rod was added for stabilization. (Source: Radiographic considerations. In: Ames C, Riew K, Abumi K, eds. Cervical Spine Deformity Surgery. 1st ed. Thieme; 2019).

Fig. 1.6 (a, b) An elderly man with chin-on-chest deformity (kyphosis) received anterior and posterior cervical osteotomies. Posterior fusion (C2–T10) was performed and resulted in significant correction of the kyphosis. (Source: Radiographic considerations. In: Ames C, Riew K, Abumi K, eds. Cervical Spine Deformity Surgery. 1st ed. Thieme; 2019).

Fig. 1.7 (a, b) An elderly woman with neck pain from myelopathy received posterior decompression and fusion (C3–C6). This was followed by a diskectomy and osteotomy (C6–C7), posterior fusion (C2–T2), and laminectomy (C6/7 and C7/T1) for decompression. (Source: Radiographic considerations. In: Ames C, Riew K, Abumi K, eds. Cervical Spine Deformity Surgery. 1st ed. Thieme; 2019).

Fig. 1.8 (a, b) Landmarks for posterior cervical tubular decompression via foraminotomy. After identifying the lamina–facet junction and other bony landmarks, commence laminar resection. (Source: Minimally invasive tubular posterior cervical decompressive techniques. In: Vaccaro A, Albert T, eds. Spine Surgery: Tricks of the Trade. 3rd ed. Thieme; 2016).

Surgical Procedure

1. Informed consent signed, preoperative labs normal, no Aspirin/Plavix/Coumadin/other anticoagulants for at least 12 days

2. Appropriate intubation and sedation

3. Horizontal skin incision 1 to 2 inches on either side of spine

4. Split thin muscle underlying skin

5. Enter the plane between sternocleidomastoid muscle and strap muscle

6. (Anterior) Enter into the plane between trachea/esophagus and carotid sheath

7. Disect away thin fascia

8. Locate disk (preoperative imaging match/intraoperative fluoroscopy)

9. Remove disk by cutting annulus...

Produkt-Details

• Erscheint lt. Verlag: 8.7.2020
• Reihe/Serie: Surgical Outlines
• Reihe/Serie: Surgical Outlines
• Verlagsort: Stuttgart
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Neurochirurgie
• Schlagworte: common neurosurgical surgeries • junior trainees • outlined neurosurgical technique • quick neurosurgical pocket reference
• ISBN-10: 1-63853-673-2 / 1638536732
• ISBN-13: 978-1-63853-673-4 / 9781638536734