Trauma

Head Injury

Neck Injury

• Nerve injury

Neurosurgery Anatomy

• Broca’s – posterior part of anterior lobe, speech motor
• Wernicke – temporal lobe, speech comprehension

Osteoradionecrosis

• Full thickness of exposed calvarial bone → Tx: debridement of the soft tissues, bone, cranioplasty with implant, and free latissimus dorsi flap

Brain tumor

• Glioma, subtype Astrocytoma MC primary brain tumor in adults.
• MC brain tumor in children is medulloblastoma. MC mets to brain in children = neuroblastoma
• Prolactinoma
  • Female Sx: menstrual cycle dysfunction (MC amenorrhea), decreased bone density, osteopenia, galactorrhea, impaired vision
  • Impaired vision = bitemporal hemianopsia or binaural hemianopsia
  • Male Sx: erectile dysfunction, decreased libido, infertility, visual Sx
• Acoustic neuroma arises from CN VIII, at cerebellopontine angle. Hearing loss, unsteady gait, vertigo, N/V.
  • Tx: surgery
• Pituitary adenoma undergoing XRT, now in shock → pituitary apoplexy
  • Tx: steroids

Asymptomatic cerebral aneurysm < 1 cm

• Tx: leave alone

Spine tumor

• Most are benign.

• #1 is neurofibroma.

• Intradural tumors are more likely to be benign, extradural tumors are more likely to be malignant

• Paraganglioma – check for metanephrines in urine

• Uncal herniation

• CN XI - exits skull through jugular foramen [9/20]

  • Cranial root (medulla) + spinal root (C1-5)
  • SCM and Trapezius muscle
  • Reach neck passing through jugular foramen and posterior triangle of neck
  • Injury = no shoulder shrug, solely a motor nerve

• Prolactin secreting pituitary adenoma [10/10]