Deck 12: Neurosurgery

Question 1

Which chemical hemostatic agent comes in compressed and noncompressed sheets and is often cut into various sizes soaked with topical thrombin and placed on oozing surfaces during neurosurgical procedures?

A)Bone wax
B)FloSeal
C)Gelfoam
D)Surgicel

Answer 1

C
An absorbable gelatin sponge (Gelfoam) absorbs and holds blood and fluid within its interstices, exerting a physical hemostatic effect. Thrombin is a drug that can be topically applied to bleeding surfaces to achieve hemostasis. Typically, Gelfoam or patties are saturated with thrombin and placed on the oozing surface. Bone wax is a hemostatic material that should be available for all cranial and spinal cord operations. Bone wax may be applied with the surgeon's fingertip or with the tip of an instrument such as a Freer or Penfield elevator. The surgeon firmly rubs or packs the wax into the bleeding surfaces of bone. The granules in a gelatin matrix (FloSeal) form a composite clot that seals a bleeding site. Regenerated cellulose (Surgicel) allows platelets and aggregates of thrombin and particulate blood elements to cling and form a coagulum that can act as a patch.

Question 2

Which of the following represents an intractable pain condition of the fifth (V) cranial nerve, also called tic douloureux, often treated with gamma knife radiosurgery, percutaneous rhizotomy, radiosurgery, or posterior fossa microvascular decompression?

A)Bell's palsy
B)Sciatica
C)Trigeminal neuralgia
D)AV malformation

Answer 2

C
Trigeminal neuralgia (tic douloureux) is characterized by excruciating, piercing paroxysms of pain, affecting one or more of the major peripheral divisions. Types of neurosurgical procedures currently recommended for trigeminal neuralgia include percutaneous rhizotomy using glycerol, radiofrequency, or balloon compression; gamma knife radiosurgery; and microvascular decompression.

Question 3

Which of the following intracranial structures provides collateral blood flow and continuity of the circulation if any one of the four main channels is interrupted?

A)Choroid plexus
B)Circle of Willis
C)Cerebral aqueduct
D)Corpus callosum

Answer 3

B
The arterial supply to the brain enters the cranium through the two internal carotid arteries anteriorly and the two vertebral arteries posteriorly. These communicate at the base of the brain through the circle of Willis, which ensures continuity of the circulation if any one of the four main channels is interrupted. The choroid plexuses of the ventricles are vascular structures that allow certain fluid elements of the blood to pass through their ependymal linings, forming cerebrospinal fluid (CSF). The cerebral aqueduct (Sylvius) is a long, narrow channel passing through the midbrain and allows passage of CSF from the lateral ventricles to the fourth ventricle. The corpus callosum is a large transverse bundle of nerve fibers that connects the right and left hemispheres of the brain.

Question 4

Which of the following are applied along the skin edges for mechanical hemostasis during opening of the scalp for craniotomy?

A)Bone wax
B)Methylmethacrylate
C)Raney clips
D)Topical thrombin

Question 5

What is the name for the division of the brain that contains the hippocampus and amygdala, which are responsible for learning and memory and regulate perceptive and expressive aspects of emotional and social behavior?

A)Basal ganglia
B)Brainstem
C)Diencephalon
D)Limbic system

Question 6

Which part of paired spinal nerves is responsible for sensory functions?

A)Anterior root
B)Dermatomes
C)Posterior root
D)Pyramidal tracts

Question 7

Which of the following diagnostic procedures involves placement of fiducials (frameless system) on the patient's head preoperatively for creation of a virtual image in three dimensions and can be used intraoperatively with a synchronized hand piece for precise targeting of intracranial lesions?

A)Digital subtraction angiography
B)Electroencephalography
C)Stereotactic MRI or CT scan
D)Wada's test

Question 8

Which of the following is the tissue most often responsible for spinal nerve root compression in patients with herniated intervertebral disks?

A)Annulus fibrosis
B)Nucleus pulposus
C)Posterior longitudinal ligament
D)Spinous process

Question 9

Select the name of the procedure for which this patient is positioned.

A)Transsphenoidal hypophysectomy
B)Infratentorial craniectomy for acoustic neuroma
C)Supratentorial stereotactic brain biopsy
D)Bilateral parietal craniotomy for subdural hematoma

Question 10

How can a surgical technologist in the scrub role efficiently assist the surgeon in microsurgical procedures so that his or her gaze need not be diverted from the microscope?

A)Keep frequently used instruments in close proximity to the surgical field.
B)Avoid sagging of the microscope drape into the field of view.
C)Hand instruments in a functional manner and guide them back into the field of view.
D)Use neutral zone transfer techniques with a basin or magnetic pad.

Question 11

Which of the 12 cranial nerves is involved in Bell's palsy and may be damaged during parotidectomy procedures?

A)Third (III)
B)Fifth (V)
C)Seventh (VII)
D)Twelfth (XII)

Question 12

What is the term for softening of brain matter or loss of brain tissue, often caused by cerebral infarct, ischemia, or trauma?

A)Abscess
B)Encephalomalacia
C)Kernicterus
D)Neurocysticercosis

Question 13

Which of the following is the minimum exposure method frequently used for evacuation of subdural hematomas, placement of ventriculoperitoneal shunts, or stereotactic brain biopsies?

A)Craniotomy
B)Burr hole
C)Craniectomy
D)Transsphenoidal

Question 14

Which surgical specialist might be asked to assist in providing exposure for the neurosurgeon in a transsphenoidal hypophysectomy (TSH) procedure?

A)Cardiothoracic surgeon
B)Neuroradiologist
C)Orthopedic surgeon
D)Otorhinolaryngologist

Question 15

Which of the following is the anatomical bloodless plane that contains loose areolar tissue and permits mobility of the scalp?

A)Subarachnoid space
B)Galea aponeurotica
C)Subgaleal space
D)Diploe table

Question 16

Which of the following types of interventional neuroradiologic endovascular procedures is less invasive than traditional surgical clipping of complex (short-necked) or difficult-to-reach intracranial aneurysms?

A)Endosaccular coiling
B)Endovascular embolization
C)Intraarterial thrombolysis
D)Balloon angioplasty

Question 17

What is a common congenital neural tube closure defect that may present as a fluid-filled sac in the lumbar region and contains neural elements?

A)Encephalocele
B)Chiari malformation
C)Hydrocephalus
D)Myelomeningocele

Question 18

The brainstem consists of which three structures?

A)Dura mater, arachnoid, pia mater
B)Midbrain, pons, and medulla oblongata
C)Mesencephalon, diencephalon, and cerebellum
D)Pons, medulla, and foramen magnum

Question 19

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

A)Falx cerebri
B)Tentorium cerebelli
C)Falx cerebelli
D)Tentorium cerebri

Question 20

Which of the following histologic classifications of brain tumors is usually benign, circumscribed and slowly growing and arises from arachnoid cells?

A)Astrocytoma
B)Craniopharyngioma
C)Meningioma
D)Oligodendroglioma