Pete Gutierrez MD, MMS, PA-C
Miami Dade College
July 2010
 Internal Carotid Artery Major branches visible
on Angiography:
◦ 1. Meningohypophysial
◦ 2.Inferolateral
◦ 3.Ophtalmic
◦...
 Circle of willis:
◦ Is form by the:
 1.Anterior communicating Artery
 2. Internal Carotid Artery
 3. Basilar Artery
...
 Hydrocephalus:
◦ General
 1. 1% prevalence ; 1/1000 congenital incidence
 Divided into three general categories:
 Com...
 Hydrocephalus:
◦ Etiologies:
 1. Congenital
 2. Hemorrhage
 3. Infectious/Inflammatory
 4. Obstructive masses
 5. P...
 Clinical Presentation:
◦ 1. ICP Headaches, nausea/vomiting, ataxia,
adbucens palsy.
◦ 2. In children check for bulging a...
 Treatment:
◦ Acetazolamide to reduce CSF production and
furosemide to promote diuresis. ( This is only
temporizing).
◦ S...
 Complications:
1. Obstruction (usually proximal)
2. Infection
3.Patient growth
4. Undershuting kinking
5. Overshuting IC...
 Carotid Artery Stenosis:
 Symptomatic or Asymptomatic
 Syncope is not consider symptomatic because
unilateral carotid ...
 Treatment:
◦ Medical therapy
 Aspirin
 Aspirin plus dipyridamole
 Clopidogrel
 Control of Hypertension
 Control of ...
 Surgical
◦ Carotid endarectomy
◦ Over medical treatment in men with asymptomatic
disease but over 60% occlusion complica...
 Central Nervous system tumors:
◦ General tumors present with progressive neurologic
deficit, motor weakness headache and...
 Supratentorial mass:
◦ Headache
◦ Nausea/vomiting
◦ Diplopia
◦ Parinaud syndrome
◦ Motor weakness
◦ Aphasia
 Low grade Astrocytoma:
◦ Approximately 12% of primary brain tumors
◦ Mostly on children
◦ Located in cerebral hemisphere...
 Malignant Glioma:
◦ Anaplastic astrocytoma
◦ Glioblastoma multiforme
◦ Approximately 40% of primary brain tumors
◦ Most ...
 Meningioma:
◦ 12% of all primary brain tumors
◦ 1.8:1 female to male ratio
◦ Arise from arachnoid cells
◦ Slow progresiv...
 Pituitary Adenoma:
◦ 10% of brain tumors
◦ Male=Female incidence
◦ Associated with multiple endocrine neoplasia (MEN)
sy...
 Medical treatment for:
◦ Prolactinomas:
 Dopamine agonists
 Surgical excision
 Acromegaly:
 Surgical resection 50% c...
 Cushing syndrome, surgery is the treatment
of choice. 85% cure rate.
 Thyroid stimulating hormone (TSH) adenomas
Medica...
 Neuroma:
◦ 8-10% of primary brain tumors:
◦ 1 in 100.000 incidence
◦ Most common affected is the CNS VIII nerve, but
any...
 Ependymona:
◦ 6% of primary brain tumors
◦ Location 4th ventricle most common
◦ Mostly occur in children
◦ Treatment sur...
 Oligodendroglioma:
◦ 4% of primary brain tumors
◦ Male >female(3:2)
◦ Mostly occur in middle age adults
◦ Slow progressi...
 Pineal tumors:
◦ One to two % of primary brain tumors
◦ Most frequent in children's
◦ Germinomas and teratomas have a ma...
 CNS Lymphoma:
◦ 1% of primary brain tumors
◦ May be primary of secondary
◦ Associated with
 AIDS
 Connective tissue di...
 This tumors tend to melt away with an initial
round of steroids treatment.
 Radiation therapy is the mainstay of
treatm...
 Other non common tumors of the brain:
◦ Epidermoid and Dermoid tumors
◦ Primitive Neuroectodermal tumors
◦ Choroid Plexu...
 Metastatic Tumors:
 More than 50%
 Common Lung Cancer
 Breast Cancer
 Renal Cell carcinoma
 Colon adenocarcinoma
 ...
 Management:
◦ Biopsy for diagnosis identification purposes
◦ Treatment for seizures
◦ Palliative
◦ Chemotherapy at time ...
 May the Force be with you?
 Break a leg?
 Enjoy Vacation!!!!!
 To be or not to Be that is the QUESTION!!!!!!!
 GO FO...
Upcoming SlideShare
Loading in...5
×

Neuro Surgery Lecture 1 - Neurology, Surgery

867

Published on

0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
867
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
62
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Neuro Surgery Lecture 1 - Neurology, Surgery

  1. 1. Pete Gutierrez MD, MMS, PA-C Miami Dade College July 2010
  2. 2.  Internal Carotid Artery Major branches visible on Angiography: ◦ 1. Meningohypophysial ◦ 2.Inferolateral ◦ 3.Ophtalmic ◦ 4. Posterior Communicating ◦ 5. Anterior choroidal ◦ 6. Middle cerebral ◦ 7. Anterior cerebral
  3. 3.  Circle of willis: ◦ Is form by the:  1.Anterior communicating Artery  2. Internal Carotid Artery  3. Basilar Artery  4. Posterior Cerebral Artery  Surgical Interventions mostly malformations.
  4. 4.  Hydrocephalus: ◦ General  1. 1% prevalence ; 1/1000 congenital incidence  Divided into three general categories:  Communicating: All ventricles affected, defect in absorption at the arachnoid granulations  No communicating (Obstructive): Block in CSF flow proximal to arachnoid granulations. This may not affect all ventricle depending on the location of the block (e.g. aqueductal stenosis spares the fourth ventricle.  Ex Vacuo: Atrophic parenchymal tissue loss results in dilated ventricles. Not pathologic Hydrocephalus.
  5. 5.  Hydrocephalus: ◦ Etiologies:  1. Congenital  2. Hemorrhage  3. Infectious/Inflammatory  4. Obstructive masses  5. Postoperative (Particular in pediatric posterior fossa procedures).
  6. 6.  Clinical Presentation: ◦ 1. ICP Headaches, nausea/vomiting, ataxia, adbucens palsy. ◦ 2. In children check for bulging anterior fontanels, increase in head circumference, irritability, poor feeding, and engorged scalp veins.
  7. 7.  Treatment: ◦ Acetazolamide to reduce CSF production and furosemide to promote diuresis. ( This is only temporizing). ◦ Shunt placement:  Most common a ventriculoperitoneal shunt is placed alternatives include ventriculoatrial and ventriculopleural shunts.  Shunts are placed similar to an extra ventricular drain except that the catheter is subcutaneously tunneled behind the ear where a valve is attached and placed in the subgaleal space.
  8. 8.  Complications: 1. Obstruction (usually proximal) 2. Infection 3.Patient growth 4. Undershuting kinking 5. Overshuting ICP 6. Subdural hematoma Evaluation is done with a Shunt series plain film to assess location of ventricular catheter Shunt O gram injection of radioisotope into shunt to confirm both proximal catheter patency and distal flow.
  9. 9.  Carotid Artery Stenosis:  Symptomatic or Asymptomatic  Syncope is not consider symptomatic because unilateral carotid occlusion rarely results in impairment of consciousness.  Evaluation:  Dopplex Ultrasound.  MR Angiogram  Carotid Angiogram
  10. 10.  Treatment: ◦ Medical therapy  Aspirin  Aspirin plus dipyridamole  Clopidogrel  Control of Hypertension  Control of DM  Control of Hyperlipidemia  Smoking cessation
  11. 11.  Surgical ◦ Carotid endarectomy ◦ Over medical treatment in men with asymptomatic disease but over 60% occlusion complication rate 3%. ◦ Procedure can be done 4-6 weeks after CVA. ◦ Risk complications:  Hoarseness (recurrent laryngeal nerve injury)  Horner syndrome  Partial tongue paresis  Hematoma causing airway complications
  12. 12.  Central Nervous system tumors: ◦ General tumors present with progressive neurologic deficit, motor weakness headache and seizure. ◦ Posterior Fossa mass:  Headache  Nausea/vomiting  Ataxia  Diplopia  Parinaud syndrome  Cranial nerve paresis  Vertical nystagmus
  13. 13.  Supratentorial mass: ◦ Headache ◦ Nausea/vomiting ◦ Diplopia ◦ Parinaud syndrome ◦ Motor weakness ◦ Aphasia
  14. 14.  Low grade Astrocytoma: ◦ Approximately 12% of primary brain tumors ◦ Mostly on children ◦ Located in cerebral hemispheres, cerebellum  Treatment:  Resected for cure  Surgery not curative for most low grade gliomas.  Radiotherapy for most postoperatively.
  15. 15.  Malignant Glioma: ◦ Anaplastic astrocytoma ◦ Glioblastoma multiforme ◦ Approximately 40% of primary brain tumors ◦ Most commonly in the erderly ◦ Treatment is palliative, not for cure.  Surgical excision  Post operative radiotherapy  Post operative chemotherapy
  16. 16.  Meningioma: ◦ 12% of all primary brain tumors ◦ 1.8:1 female to male ratio ◦ Arise from arachnoid cells ◦ Slow progresive growth ◦ Treatment:  Observe if asymptomatic  Surgical excision if symptomatic  External beam radiotherapy/knife  Outcome five year survival rate.
  17. 17.  Pituitary Adenoma: ◦ 10% of brain tumors ◦ Male=Female incidence ◦ Associated with multiple endocrine neoplasia (MEN) syndrome. ◦ Located Silla Turca ◦ Treatment:  Perform preoperative visual field testing  Pre op endocrinological evaluation
  18. 18.  Medical treatment for: ◦ Prolactinomas:  Dopamine agonists  Surgical excision  Acromegaly:  Surgical resection 50% cure rate  Avoid surgery in asymptomatic elderly patients as there is no survival benefit.  Medical therapy with octreotide (somatostatin analogue).
  19. 19.  Cushing syndrome, surgery is the treatment of choice. 85% cure rate.  Thyroid stimulating hormone (TSH) adenomas Medical treatment with octreotide.  Nonfunctional adenomas observe if asymptomatic and surgical resection otherwise.
  20. 20.  Neuroma: ◦ 8-10% of primary brain tumors: ◦ 1 in 100.000 incidence ◦ Most common affected is the CNS VIII nerve, but any cranial nerve can be involved. ◦ Usually unilateral ◦ Treatment:  Perform pretreatment audiometric and vestibular testing  Surgical resection  Conversional Radiotherapy
  21. 21.  Ependymona: ◦ 6% of primary brain tumors ◦ Location 4th ventricle most common ◦ Mostly occur in children ◦ Treatment surgical resection ◦ Radiation if located in the fourth ventricle or spinal cord ◦ Chemotherapy of little benefit ◦ Outcome 80% 5 year adult with surgical and radiation ◦ 30% 5 years survival in children
  22. 22.  Oligodendroglioma: ◦ 4% of primary brain tumors ◦ Male >female(3:2) ◦ Mostly occur in middle age adults ◦ Slow progressive present with a seizure ◦ Treatment:  Surgery  Radiotherapy  Chemotherapy  Survival 30-75% survival rate
  23. 23.  Pineal tumors: ◦ One to two % of primary brain tumors ◦ Most frequent in children's ◦ Germinomas and teratomas have a male preponderance ◦ Location pineal region and third ventricle ◦ Surgery only if well encapsulated ◦ No evidence of metastases
  24. 24.  CNS Lymphoma: ◦ 1% of primary brain tumors ◦ May be primary of secondary ◦ Associated with  AIDS  Connective tissue disease  Chronic Immunosuppression  Epstein-Barr virus infection  Male>Female (1.5:1)
  25. 25.  This tumors tend to melt away with an initial round of steroids treatment.  Radiation therapy is the mainstay of treatment  The main role of surgery is diagnosis biopsy  Surgery does not improve survival
  26. 26.  Other non common tumors of the brain: ◦ Epidermoid and Dermoid tumors ◦ Primitive Neuroectodermal tumors ◦ Choroid Plexus tumors ◦ Glomus tumors ◦ Chordoma tumors  1% of brain tumors  Surgical treatment  Chemotherapy and Radiation  Survival 70-85%
  27. 27.  Metastatic Tumors:  More than 50%  Common Lung Cancer  Breast Cancer  Renal Cell carcinoma  Colon adenocarcinoma  Most occur in the cerebral hemispheres
  28. 28.  Management: ◦ Biopsy for diagnosis identification purposes ◦ Treatment for seizures ◦ Palliative ◦ Chemotherapy at time beneficial
  29. 29.  May the Force be with you?  Break a leg?  Enjoy Vacation!!!!!  To be or not to Be that is the QUESTION!!!!!!!  GO FORTH AND CONQUER!! CONGRAT’S!!!!!!!!!!!!!!!!!!!!!!!
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×