Zerris Neurosurgical Review

For Daily Clinical Use and Oral Board Preparation
1. Auflage 2019
ISBN: 978-1-63853-629-1
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 536 Seiten, ePub

The American Board of Neurological Surgery oral examination has undergone periodic review and revision over the years, with a new format instituted in spring 2017. This review book is specifically geared to the new format. The ABNS oral examination process is relevant, rigorous, and of value to the neurosurgical specialty and the public, ensuring neurosurgeons meet the highest standards of practice.

by Vasilios A. Zerris and distinguished contributors is a multimodal and a visually rich prep tool for the ABNS exam. The resource provides a unique approach to studying and melding online didactic materials with audio-enhanced charts. Readers can use the material as a complete online exam prep course with audio, or use the print version as a quick reference guide.

Key Features

• Charts and schematics provide an excellent learning tool and study prep
• The high yield and easy to memorize format helps readers 'visualize' knowledge
• Audio files enhance the ability to create a mental framework, thereby increasing comprehension and retention of content
• Cases presented at the end of each chapter focus primarily on core material tested in the general neurosurgery ABNS exam session taken by all candidates irrespective of their declared subspecialty

This is an essential textbook for neurosurgical residents, fellows, and practitioners prepping for the ABNS boards. It also serves as a user-friendly refresher of fundamental knowledge all neurosurgeons need to know.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Autoren/Hrsg.

Zerris, Vasilios A.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie

Inhaltsverzeichnis

1 Peripheral Nerves
2 Spine and Spinal Cord
3 Vascular Neurosurgery
4 Oncology (Brain)
5 Head Injury and ICU
6 Pediatric Neurosurgery
7 Functional Neurosurgery
8 Other Diseases
9 Anatomy
10 Surgical Procedures
11 Surgical Complications
12 Neurology for Neurosurgeons

Leseproben

1 Peripheral Nerves

1.1 Diagnostic Approach for Peripheral Nerve Lesions (Table 1.1)

History

1. Symptoms (sens., weakness, atrophy) 2. Mechanism of injury 3. Chronological progression of symptoms 4. Getting better/worse? 5. Inciting events?

Examination

1. Inspection (incl. postures) 2. Palpation (e.g., mass lesion, subluxation) 3. Motor examination 4. Sensory examination (fuzzy vs. discrete borders) 5. Reflexes (UMN vs. LMN) 6. Provocative tests (e.g. Tinel’s sign) 7. Other: vascular examination, passive ROM (contractions)

Diagnostic studies

1. Electrophysiology (electromyogram [EMG], nerve conduction study [NCS]) 2. Imaging (US, CT, MRI)

1.2 Neuropathies

1.2.1 Nerve Pathologies Depending on Number and Location of Nerves Involved (Table 1.2a)

Dfn, features

Causes/specific syndromes

Mononeuropathy

One peripheral nerve involved

• Injury/iatrogenic • Compression/entrapment

Polyneuropathy

Diffuse lesions of many nerves involved: • Distal nerves > prox nerves involved • Motor + sensory (incl. pain) fibers involved

• Endocrinological diseases (DM, hypothyroidism) • Alcohol • Vitamin B12 deficiency • Heavy metals • Meds (e.g., chemotherapy) • Radiotherapy • Charcot–Marie–Tooth II (CMT II)

Mononeuritis multiplex

> 2 nerves involved in noncontiguous areas (simultaneous OR sequential)

• Autoimmune diseases (systemic lupus erythematosus [SLE], RA, sarcoid) • Vasculitis (polyarteritis nodosa)

Plexopathy

Brachial OR lumbosacral plexus involved

• Trauma • Brachial neuritis (Parsonage–Turner syndrome)

1.2.2 Other Classifications for Polyneuropathies (Table 1.2b)

• Inherited vs. acquired

• Small fiber neuropathy (e.g., DM) vs. large fiber neuropathy (AKA sensory ataxic neuropathies)

• Neuropathies with predominantly motor deficits vs. with predominantly sensory deficits

1.2.3 Causes for Neuropathies (Table 1.2c)

• Hereditary (CMT disorder)

• Traumatic (injuries, entrapment)

• Infection (Hansen’s, AIDS, Guillain–Barré)

• Autoimmune (sarcoidosis, polymyalgia rheumatica)

• Ca (paraneoplastic, CTX, RTX)

• Metabolic (hypothyroidism, DM, uremic neuropathy, amyloid)

• Medicines, toxins (heavy metals), alcohol

• Vitamin B12 deficiency

• Pseudoneuropathy

1.2.4 Peripheral Neuropathy Versus Radiculopathy (Tab. 1.2d)

Radiculopathy

Neuropathy

Sensory distribution

Fuzzy

Discrete

Muscle atrophy

No (rare)

Yes

• Utilize patterns of innervation to differential diagnosis (DDx): – Sensory nerve distribution – Motor innervation

1.3 Peripheral Nerve Injuries

1.3.1 Basics (Table 1.3a)

Nerve anatomy

Endoneurium

Surrounds myelinated OR unmyelinated axons

Perineurium

Surrounds fascicles

Mesoneurium (AKA interfascicular epineurium)

Separates fascicles

Epineurium

Surrounds nerve

1.3.2 Regeneration (Table 1.3b)

• Rate

1 mm/d ? 1 inch/mo

• Signs

– Advancing Tinel’s sign – Motor march phenomena (= motor reinnervation from prox. ? dist.)

1.3.3 Mechs of Nerve Injury (Table 1.3c)

• Trauma (compression–crush, concussive, laceration, stretch)

• Entrapment

• Ischemic

• Thermal, electrical, radiotherapy

1.3.4 Grading of Nerve Injuries (Table 1.3d)

1.3.5 Peripheral Nerve Injury Grading Systems (Table 1.3e)

(Source: Adapted from Burnett et al.1)

1.3.6 Management of Peripheral Nerve Injury (Table 1.3f)

Evaluation (identify involved nerve, mech, degree of injury, time from injury)

• Hx • P/E (motor, sens, reflexes, autonomous nervous system involvement, trophic changes) • Electrophysiology • Imaging

Management

• Conservative (PT, splinting, pain meds) • Surgical repair: – Options: ? Neurolysis ? Primary/secondary repair ± nerve graft ? Nerve transfer – Timing: rule of 3s

1.3.7 Timing of Nerve Exploration and Repair Rule of 3s (Table 1.3g)

3 d/ASAP

Sharp clean lacerations

3 wk	• Blunt lacerations • Blast injuries

3 mo	Injury in continuity: stretch, compression, etc. (Mgt: follow nerve regeneration closely by clinical examinations ± EMG, NCS) ? surgical exploration and repair if no recovery after 3 mo

1.3.8 Algorithm of Timing of Nerve Surgery2, 3 (Table 1.3h )

(Source: Adapted from Dubuisson and Kline2 and Chung et al.3)

1.3.9 Peripheral Nerve Repair: Surgical Pearls (Table 1.3i)

• Trim back to healthy nerve (fascicular) tissue

• Tension-free neurorrhaphy + least possible microsutures

• Topographic specificity (= match surface landmarks)

• Magnification (microinstruments)

• Cover repair with fibrin glue

• No overriding...