Neurocirugía.

Bloque quirúrgico II.

Dr Carlos Cohn R.
Carlos Cohn R.

01 Alumni UNIBE 2011 grad

02 Residency> Girona, Spain 2019 grad.

@drcohn

drcarloscohn@gmail.com
Silabo?
Problem
solving
 General Concepts of
Neurosurgery, Basic
Radiology, and Brain and
Spine Trauma
Introduction to Neurosurgery

● Define neurosurgery and its

scope.
● Highlight the historical
overview and advancements in
the field.
● Discuss the role of a
neurosurgeon and various
subspecialties.
Neurosurgery.

● Surgical treatment of
○ nervous system
■ brain, spinal cord, and
peripheral nerves. It
involves the
● Diagnosis, management, and
surgical intervention of various
neurological conditions to
restore or improve the function
of the nervous system.
History.
● Ancient Times: Trepanation, a
procedure in which a hole is drilled into
the skull, was performed in ancient
civilizations as a primitive form of
neurosurgery.
● 19th Century: The development of
anesthesia and aseptic techniques
paved the way for modern
neurosurgery. Sir Victor Horsley and Sir
William Macewen made significant
contributions to the field during this
period.
History.
● 20th Century: The advancements in diagnostic
imaging, such as X-ray, CT scan, and MRI,
revolutionized neurosurgery by providing detailed
anatomical information.
● Microsurgery: The introduction of the operating
microscope in the 1960s allowed for delicate and
precise manipulation of small structures, leading
to improved outcomes in neurosurgical
procedures.
● Minimally Invasive Techniques: In recent
decades, neurosurgery has seen the emergence
of minimally invasive techniques, such as
endoscopy and stereotactic radiosurgery,
reducing trauma and enhancing patient recovery.
Subspecialties.

● Neurosurgeons are highly specialized ● Subspecialties:

physicians trained to diagnose and treat a
○ Neuro-oncology.
wide range of neurological conditions.
They perform surgical interventions to ○ Vascular Neurosurgery.
treat brain tumors, neurovascular ○ Spine Surgery
disorders, spinal conditions, peripheral ○ Pediatric Neurosurgery
nerve disorders, and trauma to the nervous
○ Functional Neurosurgery:
system.
○ Neurotrauma
“MY PROFESSION IS
DECOMPRESSION”
Neuroanatomy

Highlight the importance of understanding

01 neuroanatomy for neurosurgical procedures.

02 Briefly explain the central nervous system (CNS) and

peripheral nervous system (PNS).
01

02
Neurophysiology

01 Explain neural pathways and

communication within the nervous
system.

02 Discuss the electrical activity of the brain

and its significance.
Neurosurgical Techniques
and Instruments
Highlight essential instruments used in neurosurgery.
01

02 Provide an overview of common neurosurgical

techniques.
Craneotome.

Trepano.
01

02 Craneotomo.
CRANIOTOMY.

CRANIECTOMY.

CRANIOSTOMY.
Neuronavigation.

Locating precise lesions.

Guiding resection.

Biopsy planning.
Aspiration.

01 Small fields. Visibility - blood.

Acts as dissection tool.

02 Aspiration of tumors.
Principles of
Preoperative
Evaluation and
Planning
● Discuss the importance of
thorough preoperative
evaluation.
● Highlight the key elements of
preoperative planning in
neurosurgery.
Basic Radiology in Neurosurgery

Introduce medical imaging

techniques used in neurosurgery.
● Explain the purpose and utility
of Xray, CT scan, MRI, and
angiography.
● Provide examples of when
each imaging modality is
used.
Indications and
Interpretation of
Neuroimaging Studies
01 Explain how to interpret and analyze
neuroimaging findings.

02 Discuss the indications for various

neuroimaging studies.
X rays.

Radiation.

Fractures.

Alignment.

Screening.

Follow up.
CT scan.

Ideal initial study for emergency

setting.

Bone and blood.

Radiation.

Blood Can Be Very Bad.

 B: blood look for epidural hematoma,
subdural hematoma, intraparenchymal
hemorrhage, intraventricular hemorrhage,
subarachnoid hemorrhage and (also)
extracranial hemorrhage
C: cisterns look for the presence of
blood, effacement and asymmetry in four key
cisterns (perimesencephalic, suprasellar,
quadrigeminal and Sylvian cisterns)
B: brain look for asymmetry or effacement of
the sulcal pattern, gray-white matter
differentiation (including the insular ribbon sign),
structural shifts and abnormal hypodensities
(e.g. air, edema, fat) or hyperdensities (e.g.
blood, calcification)
V: ventricles look for intraventricular
hemorrhage, ventricular effacement or shift and
for hydrocephalus
B: bone look for skull fractures (especially
basal) on bone windows (soft tissue swelling,
mastoid air cells and paranasal sinuses fluid in
the setting of trauma should raise the possibility
of a skull fracture.
MRI.

NOT ideal initial study for

emergency setting.

No radiation.

Soft tissue differentiation.

Modalities. T1 T2, STIR, ECHO,

spectroscopy…
Cerebral angiography.

Invasive.

Radiation + contrast.

Vascular lesions.
Radiological Assessment of Tumors,
Vascular Lesions, and Trauma
Explain how radiological assessments aid in the diagnosis of
tumors, vascular lesions, and trauma. Provide examples and
discuss characteristic imaging features of these conditions.
Structural and
Vascular
Malformations of the
Nervous System
This slide focuses on congenital
structural abnormalities and
vascular malformations of the
nervous system.
Congenital Structural Abnormalities
Introduce congenital structural abnormalities such as
craniosynostosis, Chiari malformation, and spina bifida.
Chiari
● Chiari malformation involves downward displacement of
the cerebellar tonsils below the foramen magnum.
● Types include I, II, III, and IV, with varying severity.
● Symptoms may include headaches, neck pain, balance
problems, and muscle weakness.
● Diagnosis through physical examination and imaging
(MRI, X-ray, CT scan).
● Treatment options include observation, medications, or
decompression surgery. Prognosis varies.
Craniosynostosis

● Craniosynostosis is a condition characterized by the

premature fusion of one or more cranial sutures.
● It can lead to abnormal skull shape and restricted brain
growth.
● Types include sagittal, coronal, metopic, and lambdoid
craniosynostosis.
● Diagnosis involves physical examination and imaging studies.
● Treatment may involve cranial vault remodeling surgery to
correct skull shape and allow for normal brain development.
Spina bifida

● Spina bifida is a neural tube defect where the spinal column

does not fully close during fetal development.
● It can result in varying degrees of damage to the spinal cord
and nerves.
● Types include spina bifida occulta, meningocele, and
myelomeningocele.
● Diagnosis through prenatal screening and imaging.
● Treatment involves multidisciplinary care and may include
surgery, physical therapy, and supportive interventions.
Vascular Malformations
Discuss vascular malformations, including arteriovenous
malformations (AVMs), cerebral aneurysms, and cavernous
malformations.
Clinical Presentation
Explain the clinical presentation of these malformations.
Diagnostic Evaluation

Explain the diagnostic evaluation

of these malformations.
Management Options
Explain the management options for these malformations.
Brain Trauma

Define traumatic brain injury (TBI) Explain the primary and Discuss the pathophysiology,
and its classification. secondary brain injuries in TBI. clinical assessment, imaging, and
management options for brain
trauma.