Carpal Tunnel Release - Open Neuro Procedures Operative Sequence.

Carpal Tunnel Release - Open

Neuro ProceduresOperative Sequence


Overall Purpose of Procedure:

Carpal Tunnel release is performed to eliminate or significantly decrease the pressure on the carpal canal and the median nerve.


Define the procedure: Cutting of the

Transverse Carpal Ligament to relieve tension in the canal.


Any condition that decreases the size of the canal may cause pressure on the median nerve with resultant symptoms of carpal tunnel syndrome. This manifests as pain and parathesia in the thumb, the index finger and the radial half of the ring finger.

Conditions which contribute to the compression of the medial nerve include (but are not limited to):

- fracture of a carpal bone, hypertrophic synovitis of RA, tumors, ganglion, lipomas, systemic conditions such as:

Obesity, diabetes melitis, thyroid dysfunction, and Raynaud's disease (is a vascular disorder that affects blood flow to the extremities) and pregnancy.

This syndrome occurs more often in women.


Wound Classification: 1

Operative Sequence 1- Incision 2- Hemostasis 3- Dissection 4- Exposure 5- Procedure (Specimen Collection

possible) 6- Hemostasis 7- Irrigation 8- Closure 9- Dressing Application


Instrumentation: Minor Ortho tray or Hand Tray.

Positioning: Supine with arms on arm boards. Affected arm on Hand Table

Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit.

Draping: Towel around tourniquet. Hand Table Drape. Possible Stockinette and Coban.


Begin your Operative Sequence Prior to Incision:

hair on patients arm is not usually removed.

Place arm on bump for circumferential prep.

Incision: Skin is marked

across volar surface.

#3 handle with #15 KB.


cont. Operative Sequence Hemostasis: Handheld Bi-Polar Bovie


cont. Operative Sequence Dissection and

Exposure: The incision is

made across the wrist surface and base of the palm to expose the Transverse Carpal Ligament.

Skin hooks, single or double toothed.

Senns.


cont. Operative Sequence Exploration and

Isolation: Care is taken to

ID the Median Nerve so that it is not damaged during the procedure.


cont. Operative Sequence

Surgical Repair: The Transverse

Carpal Ligament is incised along its entire length with a FRESH 15 KB.

Procedure can be accompanied by a Synovectomy (Surgical removal of the joint lining. Commonly performed in RA patients)

Carpal Tunnel Video

http://video.google.com/videoplay?docid=-8745070951579440267&q=Transverse+Carpal+Ligament+&ei=b90ySOnhF5KqrwLd8r2QCg&hl=en


cont. Operative Sequence Hemostasis and Irrigation:

All bleeding is controlled with cautery. Use of warm Saline to irrigate.


cont. Operative Sequence Closure:

The incision is closed in one layer. MD choice of Suture. Usually a 4-0 Nylon.

A compression dressing will be applied.


Major Arteries:Radial and Ulnar


Major Veins:Ulnar veins

Major Nerves: Ulnar and

Radial Nerve

Carpal Tunnel Release - Endoscopic

Plastic ProceduresOperative Sequence


►Overall Purpose of Procedure: Endoscopic Carpal Tunnel release is performed to eliminate or significantly decrease the pressure on the carpal canal and the median nerve through a very small incision, utilizing a scope.


►Carpal Tunnel Endoscopic

►Define the procedure:With the aid of

an arthroscope and arthrscopic instruments, the Transverse Carpal Ligament will be cut.

http://video.google.com/videoplay?docid=5218698083353890974&q=endoscopic+carpal+tunnel&ei=SeEySLPBN4jkrQKlh7CKCg&hl=en

http://video.google.com/videoplay?docid=5218698083353890974&q=endoscopic+carpal+tunnel&ei=SeEySLPBN4jkrQKlh7CKCg&hl=en

Craniotomy


Not to be confused

Craniotomy Surgical opening of

the skull necessary for brain surgery. The bone is replaced after surgery.

Craniectomy Surgical opening of

the skull necessary for brain surgery. The bone is not replaced after surgery.

Craniotomy

Overall Purpose of Procedure: a surgical operation of the cranium resulting from removal of:

Hematoma - A localized swelling filled with blood resulting from a break in a blood.

Aneurysm – widening or weakening in blood vessels in the brain.

Craniotomy

Overall Purpose of Procedure cont: Tumor removal:

There are more than 120 different types of brain tumors.

Brain tumors are often assigned different grades, ranging from a Grade I (least malignant) to Grade IV (most malignant).

It is important to note that non-malignant, or benign, brain tumors can be just as difficult to treat as malignant brain tumors.

Craniotomy

Overall Purpose of Procedure cont: Arteriovenous malformations (AVM) - A

spectrum of congenital (developmental) blood vessel malformations. An AVM occurs when brain or spinal cord arteries attach directly to veins without the blood passing through the capillary network. AVM's can cause bleeding within the nervous system (a kind of stroke), or progressive neurologic deficits, headaches or seizures.

Craniotomy

Overall Purpose of Procedure cont: Cysts Abscesses Metastatic Lesions

It is very important to know the topography of the skull to help determine your approach and to help determine the amount and extent of bone removal.

Layers of the Scalp

Craniotomy

Define the procedure: Surgery

involving the removal of skull bone to gain access to the brain and the bone is put back at the end of the operation (not always).

Craniotomy


Operative Sequence 1- Incision 2- Hemostasis 3- Dissection 4- Exposure 5- Procedure (Specimen Collection

possible) 6- Hemostasis 7- Irrigation 8- Closure 9- Dressing Application

Craniotomy Instrumentation: Neuro Tray with

Microsurgical Instruments. CT’s and MRI scans. Microscope and Laser if needed.

Positioning: Supine with arms on arm boards. Depends on area that needs correcting.

Prepping: Surgeon preference. Hibiclense or a Betadine Prep Kit.

Draping: Drape according to the area of procedure. Only expose the area worked upon.

Craniotomy Begin your Operative Sequence

Prior to Incision: Have Papaverine available

for AVM or aneurysm case for prevention of vasospasm.

Have blood product available prior to case.

Incision: Must mark skin prior to incision due to the fact that landmarks will be covered when head is draped.

Incise Skin and Galea (epicranial aponeurosis) with 10 KB.

layer of dense fibrous tissue which covers the upper part of the cranium

Craniotomy cont. Operative Sequence

Hemostasis: Handheld Bovie, Bipolar Bovie

Provide Raney Clips and Raney Clip Appliers


Dissection and Exposure: Provide a

periosteal elevator and bovie to peel scalp away from bone.

Will need to continue to coagulate galea.

Provide Fish hooks with Allis clamps and rubber bands to hold skin flap away from surgical site.

Protect skin flap with wet lap.


Exploration and Isolation: Place Burr holes

with perforator. Perforator will

have a clutch built in so that it will retract when it meets ZERO resistance.


Surgical Repair: Bone wax will be

provided to edges of cut skull bone.

Provide a Dural separator. I.E. a Penfield #3 to separate the Dura from the skull.

You will protect the galea with a retractor (Cushing).

Pass up the Midas Rex, bone saw, to connect burr holes and TURN bone flap. (can not remove at this point)


Surgical Repair: You will need to

provide the MD with the Penfield of choice to free bone flap completely from the dura.

BE SURE TO PROTECT THE BONE FLAP!

If you are going to replace the flap at the end of the case, you will need what you have removed.

In what situation would you not replace the bone flap?

Next we will need to prepare the bone flap for reinsertion at the end of the case.

The flap will be repositioned with surgical wire.

Pass up a drill to make holes in the bone flap for wires to pass.

Holes will be placed in flap and in surrounding bone.


Surgical Repair: Surgical wires

can be placed the skull at this stage or at the end of case.

Provide: Gelfoam and Thrombin, Cottonoids, Raytex’s, etc to be sure all bleeding is under control.

Hand sterile blue towels to MD to cover wires if placed prior to rest of case.

We now prepare to open the Dura.

To open the Dura, we will pass up the Dural Hook to lift it up and away from the cortex.

Hand 15 Kb to MD to nick the Dura.

Hand small scissors of choice to MD to continue opening the Dura.


Surgical Repair: MD may need

bipolar forceps or hemoclips to maintain hemostasis.

MD will need to retract the Dura. Have fish hooks ready.

Provide damp sponge or damp cottonoid patty to keep Dura moist at all times.

Continue procedure based on pathology.

If presented with an aneurysm:

Have mico-suction available to clear clot away.

Pass up self retaining retractor of choice if needed (Greenburg).

The brain's lobes are gently retracted until the location of the aneurysm is reached, using a surgical microscope and microsurgical instruments.


Surgical Repair: Aneurysm: The paper-

thin aneurysm is carefully freed from the scar tissue surrounding it, and its junction with the brain's blood vessels is identified. One of various kinds of clips is placed across the base of the aneurysm and is adjusted until its position is accurate. This allows the aneurysm to collapse, but spares the essential blood vessels around it.

At times the aneurysm will rupture again while surgery is taking place. The surgeon then carefully tries to control the hemorrhage while continuing the delicate clipping procedure.


Surgical Repair: Tumor Removal:

Once the Dura is exposed, an ultrasound probe is used to confirm the location and depth of the underlying tumor and help the surgeon plan his approach.

The tumor is carefully dissected from normal brain tissue with microsurgical instrumentation.

For an intracranial tumor, a small incision is made through the surface of the brain and into brain tissue until the tumor is reached. Ultrasound frequently is used to monitor the tumor's removal.


Surgical Repair: Tumor Removal

cont: instrumentation

may be used by the neurosurgeon to visualize, cut into, and remove the tumor, include a surgical microscope or special magnification glasses, a surgical laser that vaporizes the tumor and an ultrasonic tissue aspirator that breaks apart and suctions up the abnormal tissue.

At this time the biopsy is sent to the laboratory for analysis.

Unlike elsewhere in the body, where some extra tissue around a tumor may be surgically removed "just to be sure," only tissue that can clearly be identified as abnormal may be removed from the brain-and even then only if its removal is possible without devastating consequences.


Hemostasis and Irrigation: All bleeding is controlled with cautery. Use of warm Saline to irrigate. Provide chemical hemostatic of choice.

I.E. Surgicel.


Closure: Close Dura with suture on a small, cutting

needle. After the dura has been stitched closed, the

piece of bone is replaced and sutured/wired into place.

An ICP (intracranial pressure) monitoring device may then be implanted.

Closure of muscle and galea layer with suture of choice.

Skin staples or suture for scalp. If a drain is required, provide Nylon or

Prolene drain stitch.


ICP monitoring : Intracranial pressure monitoring is a

device, placed inside the head, which senses the pressure inside the brain cavity and sends its measurements to a recording device.

The intraventricular catheter is thought to be the most accurate method.


ICP monitoring : To insert an intraventricular catheter, a

burr hole is drilled through the skull and the catheter is inserted through the brain matter into the lateral ventricle, which normally contains liquid that protects the brain and spinal cord (cerebrospinal fluid). Not only can the intracranial pressure (ICP) be monitored, but it can be lowered by draining cerebral spinal fluid (CSF) out through the catheter.


ICP monitoring : This catheter may be difficult to place

with increased intracranial pressure, since the ventricles change shape under increased pressure and are often quite small because the brain expands around them from injury and swelling.

Normally, the ICP ranges from 1 to 15 mm Hg.


ICP monitoring : Raised intracranial pressure means that

both nervous system (neural) and blood vessel (vascular) tissues are being compressed. If left untreated, it can result in permanent neurologic damage. In some cases, it can be fatal.

Craniotomy Major Arteries and Nerves

Lumbar Discectomy

• Video

Lumbar discectomy is a surgical procedure to remove part of a problem disc in the low back. The discs are the pads that separate the vertebrae. This procedure is commonly used when a herniated, or ruptured, disc in the low back is putting pressure on a nerve root.

An incision is made down the middle of the low back. After separating the tissues to expose the bones along the low back, the surgeon takes an X-ray to make sure that the procedure is being performed on the correct disc. A cutting tool is used to remove a small section of the lamina bone.

Next, the surgeon cuts a small opening in the ligamentum flavum, the long ligament between the lamina and the spinal cord. This exposes the nerves inside the spinal canal. The painful nerve root is gently moved aside so the injured disc can be examined. A hole is cut in the outside rim of the disc.

Forceps are placed inside the hole in order to clean out disc material within the disc. Then the surgeon carefully looks inside and outside the disc space to locate and remove any additional disc fragments.

Finally, the nerve root is checked for tension. If it doesn't move freely, the surgeon may cut a larger opening in the neural foramen, the nerve passage between the vertebrae.

Before closing and suturing the wound, some surgeons will implant a special foam pad or a piece of fat over the nerve root to keep scar tissue from growing onto the nerve. Some surgeons also insert a small drain tube in the wound.

Cervical Discectomy


CERVICAL DISCECTOMY

Overall Purpose of Procedure: Pain Relief

Millions of people suffer from pain in their necks or arms. A common cause of cervical pain is a rupture or herniation of one or more of the cervical discs. This happens when the annulus of the disc tears and the soft nucleus squeezes out. As a result, pressure is placed on the nerve root or the spinal cord and causes pain in the neck, shoulders, arms and sometimes the hands. Cervical disc herniations can occur as a result of aging, wear and tear, or sudden stress like from an accident.

CERVICAL DISCECTOMY

Define the procedure:

The goal is to relieve pressure on the nerve roots or on the spinal cord by removing the ruptured disc. It is called anterior because the cervical spine is reached through a small incision in the front of the neck (anterior means front).

CERVICAL DISCECTOMY


OPERATIVE SEQUENCE 1- Incision 2- Hemostasis 3- Dissection 4- Exposure 5- Procedure (Specimen Collection possible) 6- Hemostasis 7- Irrigation 8- Closure 9- Dressing Application

CERVICAL DISCECTOMY

Instrumentation: Major Disc tray. Anterior Cervical Tray. Cervical Implant Tray.

Positioning: Supine with arms on arm boards. Head hyper extended to exposed neck.

Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit.

Draping: standard T,T,T,A, Ioban, ¾ sheet for feet in on Jackson Table, Lap sheet.

CERVICAL DISCECTOMY BEGIN YOUR OPERATIVE SEQUENCE

Prior to Incision: Incision site will marked

and shoulders will taped and placed under traction.

Incision:10 KB on one side of

the neck.

Incision will be over the effected area.

CERVICAL DISCECTOMY CONT. OPERATIVE SEQUENCE

Hemostasis: Handheld Bovie


Dissection and Exposure:Can use a retractor

such as the Versa-Trac or Shadowline to retract the fat of the neck and the muscles – sternocleidomastoid and the sternohyoid are divided, not cut.


Exploration and Isolation: After fat and muscle are pulled aside with a retractor, the disc is exposed between the vertebrae. An operating microscope may be used at this stage.


Surgical Repair: A needle is then

inserted into the disc space and an x-ray is done to confirm that the surgeon is at the correct level of the spine.

After the correct disc space has been identified on x-ray, the disc is then removed by first cutting the outer annulus fibrosis (fibrous ring around the disc) and removing the nucleus.


Surgical Repair: Dissection is carried

out from the front to back to a ligament called the posterior longitudinal ligament. Often this ligament is gently removed to allow access to the spinal canal to remove any osteophytes (bone spurs) or disc material that may have extruded through the ligament.


Surgical Repair:Once the disk is removed, we can do one of three things: 1) leave the space open to

hopefully fuse in time – not common.

2) place a bone graft for support in between to vertebral bodies without the aid of a plate (less common).

3) More commonly – place a cervical plate over the bone graft to hold it in place and ensure fusion.


Hemostasis and Irrigation:All bleeding is controlled with cautery. Use of warm Saline to irrigate.


Closure:Small 3-0 or 4-0 Vicryl followed by Monocryl for a

plastics type closure.


Complications:Possible risks and complications of

anterior cervical discectomy surgery may include:

Inadequate symptom reliefFailure of bone graft healing (a.k.a. non-union

or pseudarthrosis)Persistent swallowing or speech disturbanceNerve root damageDamage to the spinal cord (about 1 in 10,000)Bleeding InfectionDamage to the trachea/esophagus


Complications: The small nerve that supplies innervation to the vocal

cords (recurrent laryngeal nerve) will sometimes not function for several months after neck surgery because of retraction during the procedure, which can cause temporary hoarseness. Retraction of the esophagus can also produce difficulty with swallowing, which has usually resolved within a few weeks to months.

There is little chance of a recurrent disc herniation because most of the disc is removed with this type of surgery.

Anterior Cervical Decompression & Spine Fusion Video

http://video.google.com/videoplay?docid=-8464953369622155694&q=Anterior+Cervical+Decompression+&+Spine+Fusion&ei=16k1SJveOIim-QGH4YzoCQ&hl=en

CERVICAL DISCECTOMY

Major Arteries:Superior Thyroid Artery

http://upload.wikimedia.org/wikipedia/commons/5/52/Superior_thyroid.PNG

CERVICAL DISCECTOMY

Major Veins:Middle and Inferior

Thyroid vein.

Major Nerves: Spinal Cord

Ventriculoperitoneal Shunt



• Overall Purpose of Procedure:

• VP shunts are placed to treat hydrocephalus (hydro = water, cephalus = head) that can result from a number of diseases including: subarachnoid hemorrhage, meningitis, or tumors.

• Mostly commonly performed on children.

• Hydrocephalus is a condition that occurs due to an obstruction in the ventricular system, an overproduction of CSF by a rare tumor called a Choroid Plexus Papilloma, or an imbalance of production or reabsorption of CSF.

• Hydrocephalus can be acquired or congenital.• It is recognized by dilation of the ventricles on CT

or MRI.


• Define the procedure: Ventriculoperitoneal

(VP) shunt insertion is an operation performed to place a catheter into a brain ventricle to drain cerebrospinal fluid (CSF) from the ventricular system into the peritoneal space.


• Anatomy:• CSF is produced

within the Choroid Plexus within the four normally communicating ventricles of the brain.

• The CSF acts as a cushion to protect the brain from mechanical trauma and assists with intracranial pressure (ICP)


• The Shunt: Ventriculoperitoneal

(VP) shunt is a small catheter that drains excess CSF from a ventricle in the brain to another area in the body.

• One end of the shunt is in the ventricle inside the patients brain where the extra CSF is causing problems.

• A small valve in the tube controls the pressure in the patients head by controlling the amount of fluid running through it.

• It also makes sure the fluid flows in only one direction, away from the brain.

• The catheter tubing continues on to an area where the body can reabsorb the fluid. The most common area is the stomach area (abdomen).


• The Shunt:• Shunts usually

consist of three parts:

• (1) Proximal end that is radiopaque and is placed into the ventricle. This end has multiple small perforations.

• (2) Valve- this allows for unidirectional flow. Can adjust various opening pressures. Usually has a reservoir that allows for checking shunt pressure and sampling CSF

• (3) Distal end that is placed into the peritoneum or another absorptive surface by tracking the tubing subcutaneously


• Wound Classification: 1

Operative Sequence• 1- Incision• 2- Hemostasis• 3- Dissection • 4- Exposure• 5- Procedure (Specimen Collection

possible)• 6- Hemostasis • 7- Irrigation• 8- Closure• 9- Dressing Application


• Instrumentation: Minor tray. Spine Tray. Drill for Burr holes.

• Positioning: Supine with arms on arm boards. Head turned to the side for catheter placement.

• Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit. Will prep head ( 2 incisions) and belly (sub- xiphoid incision).

• Draping: Head drape, standard belly draping with Blue Towels and Lap drape.

Ventriculoperitoneal Shunt Begin your Operative Sequence

• Prior to Incision:• Since most shunts

are done on children, warm the room.

• Must shave the pt’s head.

• Incision:• Two small incisions

are made in the scalp.• Later, will have

another incision, sub- xiphoid, for distal end of catheter.

Ventriculoperitoneal Shunt cont. Operative Sequence

• Hemostasis: Handheld Bovie and Bipolar bovie


• Dissection and Exposure:• Head – retract the

skin flap with skin hooks or Senns.

• Provide a periosteal elevator,

• Followed by a burr.• Burr will be used

to make an access port for shunt/catheter.

• Now make the abdominal incision.

• Incise down to the peritoneum.

• Provide retractors, forceps and scissors for this step.

• The peritoneum is not opened at this time.

• The distal catheter is left lying on top of the peritoneum at this point in the procedure.


• Exploration and Isolation:

• Retractors placed in head and in abdomen to expose surgical sites.


• Surgical Repair:• A tunneling

device is inserted distally. The tunneling is usually done distally to proximally.

• Be sure to provide an a tissue obturator to prevent tissue damage.

• You will pass the distal catheter next. Check patency by flushing with normal saline.

• This distal catheter is very long.

• Clamp to the draped with rubber shods to prevent form falling off field.

• If the type of catheter has an external valve it is placed behind the patients ear (another incision). If not, then the valve is internal (passed to the second incision or just distal) and will automatically control the flow of CSF.


• Surgical Repair:• Connect the

valve to the proximal end of the distal catheter.

• Make sure the arrow that depicts the flow of fluid is pointed towards the patients feet.

• This will be secured in place with small NON-absorbable sutures.

• Now we will open the Dura with a 15kb.

• Once the Dura is open and retracted, we will begin threading the ventricular catheter.

• A stylet will be inserted into this catheter to provide stability.

• Most catheters have distal markers for placement determination under fluoroscopy.


• Surgical Repair:• Provide the MD

with a TB syringe filled with antibiotic of choice. MD will flush ventricular catheter with this antibiotic solution.

• MD will need to cut the ventricular catheter to the desired length so provide small scissors.

• Have a medicine cup ready to collect CSF for the lab.

• Be prepared to hand off this specimen ASAP.

• MD will then connect the ventricular catheter to the proximal end of the valve.

• Suture into place.• MD will move back to

the abdomen.• MD will want to

visualize the flow of CSF before the catheter is placed through the peritoneum.


• Surgical Repair:• To lift the

peritoneum, pass two hemostats or mosquitoes and a 15 KB.

• A small incision is made.

• The distal end of the catheter is placed into the abdominal cavity, leaving plenty of coil for growth (in the infant and child patient).


cont. Operative Sequence• Hemostasis and Irrigation:

• All bleeding is controlled with cautery. • Use of warm Saline to irrigate.


cont. Operative Sequence• Closure:

• Provide suture of choice to secure the distal catheter to the peritoneum.

• Closure of the peritoneum – surgeon choice of absorbable suture.

• Same with skin and head incisions.• Frequent antibiotic washing is used

during the closure process.


• Major Arteries:• Anterior,

Middle, Posterior Cerebral Artery.

• Mostly superficial vessels.

• All vascularity is monitored due to the extensive tunneling process.


• Major Veins:Superficial vessels

Major Nerves:The brain!

DBS


http://upload.wikimedia.org/wikipedia/commons/9/91/Parkinson_surgery.jpg

DBS Dystonia is a neurological movement disorder in which

sustained muscle contractions cause twisting and repetitive movements or abnormal postures.

Dystonia def: Dystonia video

Primary dystonia is suspected to be caused by a pathology of the central nervous system, likely originating in those parts of the brain concerned with motor function, such as the basal ganglia, and the GABA (gamma-aminobutyric acid) producing Purkinje neurons. The precise cause of primary dystonia is unknown. In many cases it may involve some genetic predisposition towards the disorder combined with environmental conditions.

Dystonia and DBS: Dystonia and DBS video

http://video.google.com/videoplay?docid=5569613082899478620&q=dystonia&ei=2JFGSMinD5O0rgLP-ZyXDA&hl=en

http://www.youtube.com/watch?v=W677UrsM-Vghttp://video.google.com/videoplay?docid=2182583111712490668&q=Dystonia+disease&ei=v45GSIi3F4r2rQKu18CfDA&hl=en

Dystonia

Secondary dystonia refers to dystonia brought on by some identified cause, usually involving brain damage, or by some unidentified cause such as chemical imbalance. Some cases of (particularly focal) dystonia are brought on after trauma, are induced by certain drugs (tardive dystonia), or may be the result of diseases of the nervous system such as Wilson's disease.

Symptoms of Dystonia Symptoms vary according to the kind of dystonia

involved. In most cases, dystonia tends to lead to abnormal posturing, particularly on movement. Many sufferers have continuous pain, cramping and relentless muscle spasms due to involuntary muscle movements.

Early symptoms may include loss of precision muscle coordination (sometimes first manifested in declining penmanship, frequent small injuries to the hands, dropped items and a noticeable increase in dropped or chipped dishes), cramping pain with sustained use and trembling. Significant muscle pain and cramping may result from very minor exertions like holding a book and turning pages.

Parkinson's disease

Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills and speech, as well as other functions.

Vid: Understanding Parkinson's Disease Video

http://video.google.com/videoplay?docid=-6084789560963853127&q=Parkinson's+disease&ei=BY5GSOS0I6X0rALwg6mwDA&hl=enhttp://video.google.com/videoplay?docid=-6084789560963853127&q=Parkinson's+disease&ei=BY5GSOS0I6X0rALwg6mwDA&hl=en

Parkinson's disease

Parkinson's disease belongs to a group of conditions called movement disorders. It is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia). The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain.

DBS

Overall Purpose of Procedure:

The news story: Vanderbilt Deep Brain Stimulation Video

The procedure: OR Live

http://video.google.com/videoplay?docid=-4447337006004898411&q=deep+brain+stimulators&ei=fak9SL3aGIH4rQKw3tWbBA&hl=enhttp://video.google.com/videoplay?docid=-4447337006004898411&q=deep+brain+stimulators&ei=fak9SL3aGIH4rQKw3tWbBA&hl=en

http://www.or-live.com/STJoseph/2042/event/rnh.cfm?

Summary

• A & P• Pathology• Diagnostics/Pre-operative Testing• Medications/Anesthesia• Positioning/Prepping/Draping• Supplies/Instrumentation/Equipment• Dressings/Drains/Post-op Care• Procedures: Carpal Tunnel Release, Craniotomy,

Cervical Discectomy, Lumbar Discectomy, Ventroperitoneal Shunt

Carpal Tunnel Release - Open Neuro Procedures Operative Sequence.

Documents

Transcript of Carpal Tunnel Release - Open Neuro Procedures Operative Sequence.