Rapid Acquisition Of Key Concepts - Neurosurgery

Tyre 0

Tyre 1

Tyre 2

Tyre 3

• Measures include 
  • Head-end elevation (30 degrees) 
  • Maintaining MAP >70 mmHg
• If the Glasgow coma score is <8, MAP should be >80 mmHg
• After following the above measures if the ICP is not controlled, Tyre 1 is considered. 

• Measure include
  • Osmolar therapy by using 20% mannitol and 3% hypotonic saline
  • Short-term hyperventilation (shirt term) to maintain PaCO2 of 30 to 34 mmHg 
  • CSF drainage 
• After following the above measures if the ICP is not controlled, Tyre 2 is considered.

• Measure includes.
  • Complete paralysis using rocuronium or other long-acting or short-acting muscle relaxant
  • Mild hypothermia (up to 35 degrees)
  • Mild hyperventilation (persistent) to maintain PaCO2 of 30 to 34 mmHg 

• Measure include
  • Surgical decompression 
  • Hypothermia (up to 34 degrees)
  • Barbiturate coma (MCQ) 

Traumatic

SAH

• RBC count – Declines as drain further
• Supernatant fluid – Clean
• Clotting – Usually clots
• OP – Normal or low 

• Remains almost consistent 
• Xanthochromic 
• No clotting 
• High 

Spina bifida aperta

Spina bifida occulta

• It is an open defect.

• It is a closed defect.

• It is not covered with intact skin but covered by scar tissues or meninges.

• It is covered by normal skin.

• Associated with CSF leak and meningitis signify poor prognosis.

• Skin tags, tuft of hair and dermal sinus may be present.

• Examples of Spina bifida aperta are:
  • Meningomyelocele
  • Meningocele
  • Myeloschisis

• Examples of Spina bifida occulta are:
  • Lipomeningomyelocele
  • Dermoid

Fracture

Named Classification

C1 vertebra

Jefferson's fracture

• Jefferson's fracture is a fracture of both the anterior and posterior part of the C1 vertebra.

Fracture of the odontoid process

Anderson and D. Alonso classification.

• Alonso's classification is divided into three parts.

C2-C3 traumatic spondylolisthesis

Hangman's Fracture

Thoracic and lumbar regions

TLICS scoring system

• Thoraco-lumbar injury classification system

Sub axial cervical spine from C3 to C7

SLICS classification

• Sub axial cervical spine injury classification system

Ideal case

Kernohan’s notch phenomenon

• Right-sided uncal herniation
• Causes
• Right-sided 3rd nerve palsy
• Causes
• Left-sided weakness

• Right-sided uncal herniation
• Causes
• Right-sided 3rd nerve palsy
• Causes
• Right-sided weakness

Note: Kernohan’s notch phenomenon is called false localizing sign