Neurosurgery rounds: questions and answers

481 Pages·2011·9.62 MB·English

by  Mark Shaya

Neurosurgery Rounds
Questions and Answers
7050034FM.indd 1 3/5/11 8:55:35 PM
7050034FM.indd 2 3/5/11 8:55:35 PM
Neurosurgery Rounds
Questions and Answers
Mark R. Shaya, MD, FACS
Chief Executive Officer
Neurosurgical Institute of Florida
University of Miami Hospital
Miami, Florida
Remi Nader, MD, CM, FRCSC, FACS, FAANS
Chief, Neurosurgery Section
Director, Neuroscience Clinical Effectiveness Program
Memorial Hospital at Gulfport
Affiliate Assistant Professor of Neurosurgery
University of Mississippi Medical Center
Attending Neurosurgeon
Gulf Coast Brain and Spine Institute
Gulfport, Mississippi
Jonathan S. Citow, MD
Lake County Neurosurgery
Chief of Neurosurgery, Condell Medical Center
Libertyville, Illinois
Associate Clinical Professor
Rosalind Franklin University
North Chicago, Illinois
Hamad I. Farhat, MD
Section Head
Neurovascular and Neuroendovascular Surgery
NorthShore Medical Group, Neurosurgery
Evanston Hospital
Evanston, Illinois
Assistant Clinical Professor
University of Chicago
Chicago, Illinois
Abdulrahman J. Sabbagh, MD, FRCSC
Deputy Chairman, Department of Neurosurgery
Director, Neurosurgery Residency Program
Neurosciences Center
King Fahd Medical City—Ministry of Health
Riyadh, Saudi Arabia
Thieme
New York • Stuttgart
7050034FM.indd 3 3/5/11 8:55:36 PM
Thieme Medical Publishers, Inc.
333 Seventh Ave.
New York, NY 10001
Executive Editor: Kay D. Conerly
Managing Editor: Lauren Henry
Editorial Director: Michael Wachinger
Production Editor: Marcy Ross
International Production Director: Andreas Schabert
Vice President, International Marketing and Sales: Cornelia Schulze
Chief Financial Officer: James W. Mitos
President: Brian D. Scanlan
Compositor: MPS Limited, a Macmillan Company
Printer: Sheridan Press
Library of Congress Cataloging-in-Publication Data: Available from the
publisher upon request.
Copyright © 2011 by Thieme Medical Publishers, Inc. This book, including
all parts thereof, is legally protected by copyright. Any use, exploitation, or
commercialization outside the narrow limits set by copyright legislation
without the publisher’s consent is illegal and liable to prosecution. This
applies in particular to photostat reproduction, copying, mimeographing
or duplication of any kind, translating, preparation of microfilms, and elec-
tronic data processing and storage.
Important note: Medical knowledge is ever-changing. As new research and
clinical experience broaden our knowledge, changes in treatment and drug
therapy may be required. The authors and editors of the material herein
have consulted sources believed to be reliable in their efforts to provide
information that is complete and in accord with the standards accepted at
the time of publication. However, in view of the possibility of human error
by the authors, editors, or publisher of the work herein or changes in medi-
cal knowledge, neither the authors, editors, nor publisher, nor any other
party who has been involved in the preparation of this work, warrants that
the information contained herein is in every respect accurate or complete,
and they are not responsible for any errors or omissions or for the results
obtained from use of such information. Readers are encouraged to confirm
the information contained herein with other sources. For example, readers
are advised to check the product information sheet included in the package
of each drug they plan to administer to be certain that the information con-
tained in this publication is accurate and that changes have not been made
in the recommended dose or in the contraindications for administration.
This recommendation is of particular importance in connection with new
or infrequently used drugs.
Some of the product names, patents, and registered designs referred to
in this book are in fact registered trademarks or proprietary names even
though specific reference to this fact is not always made in the text. There-
fore, the appearance of a name without designation as proprietary is not
to be construed as a representation by the publisher that it is in the public
domain.
Printed in the United States of America
5 4 3 2 1
ISBN 978-1-58890-499-7
7050034FM.indd 4 3/5/11 8:55:37 PM
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Contributors . . . . . . . . . . . . . . . . . . . . . . . ix
I BASIC NeuRoSCIeNCeS
1 Neuroanatomy . . . . . . . . . . . . . . . . . . . . .1
Cranial . . . . . . . . . . . . . . . . . . . . . . . . .2
Spine .and .Peripheral .Nerve . . . . . . . . . . . .42
Cases . . . . . . . . . . . . . . . . . . . . . . . . .55
2 Neurophysiology . . . . . . . . . . . . . . . . . . 63
General . . . . . . . . . . . . . . . . . . . . . . . .64
Cases . . . . . . . . . . . . . . . . . . . . . . . . .90
3 Neuropathology . . . . . . . . . . . . . . . . . . . 97
Congenital . . . . . . . . . . . . . . . . . . . . . .98
Trauma . . . . . . . . . . . . . . . . . . . . . . .102
Epilepsy . . . . . . . . . . . . . . . . . . . . . . .104
Neoplastic . . . . . . . . . . . . . . . . . . . . .110
Degenerative . . . . . . . . . . . . . . . . . . . .123
4 Neuropharmacology . . . . . . . . . . . . . . . 127
Neurotransmitters . . . . . . . . . . . . . . . . .128
Epilepsy . . . . . . . . . . . . . . . . . . . . . . .133
Anesthetics, .Analgesics, .and . .
. Antiinflammatories . . . . . . . . . . . . . .135
Antimicrobials . . . . . . . . . . . . . . . . . . .142
Intensive .Care: .Vasogenic .and . .
. Hematologic . . . . . . . . . . . . . . . . . .145
Toxicology . . . . . . . . . . . . . . . . . . . . .149
II CLINICAL NeuRoSCIeNCeS
5 Cranial Neurosurgery. . . . . . . . . . . . . . . 153
General . . . . . . . . . . . . . . . . . . . . . . .154
Trauma .and .Emergencies . . . . . . . . . . . . .175
Neoplasms . . . . . . . . . . . . . . . . . . . . .187
Endocrine . . . . . . . . . . . . . . . . . . . . .207
Radiation .Therapy . . . . . . . . . . . . . . . . .213
Infections . . . . . . . . . . . . . . . . . . . . . .215
Vascular . . . . . . . . . . . . . . . . . . . . . . .218
Congenital .and .Pediatric . . . . . . . . . . . . .240
Pain .and .Functional . . . . . . . . . . . . . . . .252
Cases . . . . . . . . . . . . . . . . . . . . . . . .255

7050034FM.indd 5 3/5/11 8:55:37 PM
vi Contents
6 Spine. . . . . . . . . . . . . . . . . . . . . . . . . 281
Spinal .Anatomy .and .Surgical .Technique . . . .282
Trauma . . . . . . . . . . . . . . . . . . . . . . .305
Degenerative . . . . . . . . . . . . . . . . . . .324
Neoplastic, .Infectious, .Vascular . . . . . . . . .332
Congenital .and .Pediatric . . . . . . . . . . . . .342
Cases . . . . . . . . . . . . . . . . . . . . . . . .346
7 Peripheral Nerves . . . . . . . . . . . . . . . . . 357
General . . . . . . . . . . . . . . . . . . . . . . .358
Upper .Extremity . . . . . . . . . . . . . . . . .370
Lower .Extremity . . . . . . . . . . . . . . . . .379
Cases . . . . . . . . . . . . . . . . . . . . . . . .385
8 Neurology . . . . . . . . . . . . . . . . . . . . . 391
General . . . . . . . . . . . . . . . . . . . . . . .392
Emergencies .and .Epilepsy . . . . . . . . . . . .394
Infectious .and .Inflammatory . . . . . . . . . .397
Congenital .and .Pediatric . . . . . . . . . . . . .404
Functional .and .Pain . . . . . . . . . . . . . . . .411
Cases . . . . . . . . . . . . . . . . . . . . . . . .413
9 Neuroradiology . . . . . . . . . . . . . . . . . . 423
Cranial . . . . . . . . . . . . . . . . . . . . . . .424
Spinal . . . . . . . . . . . . . . . . . . . . . . . .433
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
7050034FM.indd 6 3/5/11 8:55:38 PM
Preface
The front cover of this text shows neurosurgical pioneer
Dr. Harvey Cushing on rounds almost a century ago with
residents, students, and nurses examining a patient after
a craniotomy. It is truly extraordinary to see this patient
without all the bedside machines, monitors, and tubes we
are used to seeing today. Although the science and techno-
logic armamentarium have progressed over the years, the
true didactics of neurosurgery remain essentially as they
were at the time this picture was taken.
The amount of information required to complete neu-
rosurgery residency training can be very intimidating and
broad. The diagnosis and management of neurosurgical
diseases is an ever-advancing field that remains challeng-
ing for both the trainees and mentors.
The purpose of this book is to provide diversified cover-
age of the multiple disciplines that are involved and inter-
twined in the understanding, care, and treatment of neu-
rosurgical patients. Although its primary use will be for
review purposes by the trainee, resident, or medical stu-
dent prior to being “pimped” by their mentor about topics
in neurosurgery, the book also provides a handy reference
guide that the reader can fall back upon in reviewing spe-
cific topics as they relate to simple and complex neurosur-
gery and neuroscience issues.
The book is divided into two sections including basic and
clinical neurosciences. The sections are further composed
of four to five subsections including neuroanatomy, neuro-
physiology, neuropathology, neuropharmacology, cranial
neurosurgery, spine, peripheral nerves, neurology, and
neuroradiology. By providing this organization we have
attempted to cover all categories involved in the practice
and understanding of neurosurgical diseases, both from
a basic science and clinical standpoint. With 23 authors,
contributors, and collaborators from four countries, in-
cluding not only neurosurgeons but also specialists in
neuropathology, neuroradiology, orthopedic surgery, an-
esthesiology, and neurology, we have attempted to cover
as broadly as possible—yet in a concise manner—specific
topics that will come up in the day-to-day evaluation and
treatment of neurosurgical patients.
This book was edited as a combined effort from the
experts in the now new field of neurosurgical .review to
bring to the reader the optimal didactic experience. We
ii
7050034FM.indd 7 3/5/11 8:55:38 PM
viii Preface
have attempted to present material in a way to best facili-
tate the retention and understanding of complex concepts
and rare diseases by breaking them down to their bare
essentials.
We hope that you enjoy reading this book as much as we
did putting it together.

Mark .Shaya, .MD
Remi .Nader, .MD
7050034FM.indd 8 3/5/11 8:55:39 PM
Contributors
Nazek Ahmad, MD (Cranial .Neurosurgery–Pediatric)
Neurosurgery Resident
Department of Neurosurgery
Neurosciences Center
King Fahd Medical City
Riyadh, Saudi Arabia
Mohammd Alfawareh, MD (Spine)
Subspecialty Consultant Spine Surgeon, Pediatric Spine
Surgeon, Musculoskeletal Oncology Surgeon
Spine Surgery Department
Neurosciences Center
Part-time Orthopedic Surgery Section, Department of
Surgery
King Fahd Medical City
Riyadh, Saudi Arabia
Aisha Nassr Al-Hajjaj, MD (Neuroradiology)
Subspecialty Consultant Neurosurgeon,
Neuro-endovascular Interventionist
Department of Neurosurgery
Neurosciences Center
King Fahd Medical City
Riyadh, Saudi Arabia
Tamer Altay, MD (Neuroradiology)
Assistant Professor
Department of Neurosurgery
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Gmaan Alzahrani, MD (Cranial .Neurosurgery–Pediatric)
Neurosurgery Resident
Department of Neurosurgery
Neurosciences Center
King Fahd Medical City
Riyadh, Saudi Arabia
Walid I. Attia, MD, MSc, PhD (Spine)
Subspecialty Consultant
Neurosurgery Department, Spine Surgery Department
Director, Spine Fellowship Program
Neurosciences Center
King Fahd Medical City
Riyadh, Saudi Arabia
ix
7050034FM.indd 9 3/5/11 8:55:39 PM