Neurosurgery is a specialized field focused on the surgical management of pathologies of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification, spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy, spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy, and peripheral nerves Peripheral Nerves The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. Nervous System: Histology. General neurosurgery includes cases of trauma and emergencies. There are a number of specialized neurosurgical practices, including oncologic neurosurgery, spinal neurosurgery, and pediatric neurosurgery. Common neurosurgery cases treat tumors, masses, herniations, various types of hemorrhages, and radicular pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways. Although neurosurgery is a surgical specialty, neurosurgeons must be very competent in neurology, critical care, trauma care, and radiology.
Last updated: 6 May, 2022
The surgeon needs to be aware of the important structures at the site where the surgery occurs, being especially careful not to damage delicate neurovascular structures.
Layer | Characteristics |
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Epidural space Epidural space Space between the dura mater and the walls of the vertebral canal. Epidural Hemorrhage |
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Dura mater Dura mater The outermost of the three meninges, a fibrous membrane of connective tissue that covers the brain and the spinal cord. Meninges: Anatomy |
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Subdural space Subdural space Potential cavity which separates the arachnoid mater from the dura mater. Subdural Hemorrhage |
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Arachnoid mater
Arachnoid mater
A delicate membrane enveloping the brain and spinal cord. It lies between the pia mater and the dura mater. It is separated from the pia mater by the subarachnoid cavity which is filled with cerebrospinal fluid.
Meninges: Anatomy ( leptomeninges Leptomeninges Meninges: Anatomy) |
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Subarachnoid space Subarachnoid space The space between the arachnoid membrane and pia mater, filled with cerebrospinal fluid. It contains large blood vessels that supply the brain and spinal cord. Subarachnoid Hemorrhage |
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Pia mater
Pia mater
The innermost layer of the three meninges covering the brain and spinal cord. It is the fine vascular membrane that lies under the arachnoid and the dura mater.
Meninges: Anatomy ( leptomeninges Leptomeninges Meninges: Anatomy) |
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The ventricular system Ventricular System The ventricular system is an extension of the subarachnoid space into the brain consisting of a series of interconnecting spaces and channels. Four chambers are filled with cerebrospinal fluid (CSF): the paired lateral ventricles, the unpaired 3rd ventricle, and the unpaired 4th ventricle. Ventricular System: Anatomy is composed of the following structures:
Ventricular system
Ventricular System
The ventricular system is an extension of the subarachnoid space into the brain consisting of a series of interconnecting spaces and channels. Four chambers are filled with cerebrospinal fluid (CSF): the paired lateral ventricles, the unpaired 3rd ventricle, and the unpaired 4th ventricle.
Ventricular System: Anatomy isolated from the
brain
Brain
The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem.
Nervous System: Anatomy, Structure, and Classification:
Note the
lateral ventricles
Lateral ventricles
Cavity in each of the cerebral hemispheres derived from the cavity of the embryonic neural tube. They are separated from each other by the septum pellucidum, and each communicates with the third ventricle by the foramen of monro, through which also the choroid plexuses (choroid plexus) of the lateral ventricles become continuous with that of the third ventricle.
Ventricular System: Anatomy, the 3rd ventricle in the center, and the 4th ventricle toward the bottom.
The arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology that supply the skull Skull The skull (cranium) is the skeletal structure of the head supporting the face and forming a protective cavity for the brain. The skull consists of 22 bones divided into the viscerocranium (facial skeleton) and the neurocranium. Skull: Anatomy and its contents can be divided into 2 large groups.
Major branches of the external carotid artery External carotid artery Branch of the common carotid artery which supplies the exterior of the head, the face, and the greater part of the neck. Carotid Arterial System: Anatomy
Image by BioDigital, edited by LecturioThe venous drainage system of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification is located between the endosteal and meningeal layers of dura mater Dura mater The outermost of the three meninges, a fibrous membrane of connective tissue that covers the brain and the spinal cord. Meninges: Anatomy. These vessels are lined by endothelium Endothelium A layer of epithelium that lines the heart, blood vessels (vascular endothelium), lymph vessels (lymphatic endothelium), and the serous cavities of the body. Arteries: Histology and have no valves or smooth muscle cells in their walls.
The following sinuses are in contact with the bones of the skull Skull The skull (cranium) is the skeletal structure of the head supporting the face and forming a protective cavity for the brain. The skull consists of 22 bones divided into the viscerocranium (facial skeleton) and the neurocranium. Skull: Anatomy:
Venous sinuses
Venous sinuses
Veins: Histology of the middle and posterior fossa
IJV:
internal jugular vein
Internal jugular vein
Parapharyngeal Abscess
The intervertebral disk space is highlighted in this image.
Image: “ Intervertebral disc Intervertebral disc Any of the 23 plates of fibrocartilage found between the bodies of adjacent vertebrae. Vertebral Column: Anatomy” by Phil Schatz. License: CC BY 4.0Components of vertebrae
Image by BioDigital, edited by LecturioDepending on the location, a craniotomy is:
When used for decompression, the craniotomy/craniectomy procedure turns the intracranial compartment from a semirigid shape into an elastic Elastic Connective Tissue: Histology container.
Intraoperative images of craniotomy:
A: The 2-part craniotomy is elevated to reveal intact dura spanning the
transverse sinus
Transverse sinus
The two large endothelium-lined venous channels that begin at the internal occipital protuberance at the back and lower part of the cranium and travels laterally and forward ending in the internal jugular vein (jugular veins). One of the transverse sinuses, usually the right one, is the continuation of the superior sagittal sinus. The other transverse sinus is the continuation of the straight sinus.
Cerebrovascular System: Anatomy.
B: The inner concavity of the 2-part
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types flap is seen. The Penfield #4 instrument points to the imprint of the
transverse sinus
Transverse sinus
The two large endothelium-lined venous channels that begin at the internal occipital protuberance at the back and lower part of the cranium and travels laterally and forward ending in the internal jugular vein (jugular veins). One of the transverse sinuses, usually the right one, is the continuation of the superior sagittal sinus. The other transverse sinus is the continuation of the straight sinus.
Cerebrovascular System: Anatomy.
C: The 2
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types pieces have been fixed to each other on the internal surface; here, the external convexity is restored with an excellent anatomic cosmetic result.
A ventriculostomy is an opening created to communicate the cerebral ventricles with a sterile Sterile Basic Procedures extracranial space. The therapeutic goal is drainage of CSF contained within the ventricles, decompression of intracranial spaces, and a decrease in the ICP ICP Normal intracranial pressure (ICP) is defined as < 15 mm Hg, whereas pathologically increased ICP is any pressure ≥ 20 mm Hg. Increased ICP may result from several etiologies, including trauma, intracranial hemorrhage, mass lesions, cerebral edema, increased CSF production, and decreased CSF absorption. Increased Intracranial Pressure (ICP).
A VP shunt is a surgically created communication Communication The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups. Decision-making Capacity and Legal Competence between the cerebral ventricles and the peritoneal cavity Peritoneal Cavity The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of winslow, or epiploic foramen. Peritoneum: Anatomy. The aim of this treatment is to drain CSF within the ventricles and decrease ICP ICP Normal intracranial pressure (ICP) is defined as < 15 mm Hg, whereas pathologically increased ICP is any pressure ≥ 20 mm Hg. Increased ICP may result from several etiologies, including trauma, intracranial hemorrhage, mass lesions, cerebral edema, increased CSF production, and decreased CSF absorption. Increased Intracranial Pressure (ICP).
Ventriculoperitoneal shunt in an infant with important structures, such as the valve, reservoir Reservoir Animate or inanimate sources which normally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks. Reservoirs are distinguished from vectors (disease vectors) and carriers, which are agents of disease transmission rather than continuing sources of potential disease outbreaks. Humans may serve both as disease reservoirs and carriers. Escherichia coli, and burr hole Burr Hole Subdural Hemorrhage, labeled
Image by Lecturio.Spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy decompression surgery Decompression surgery A surgical operation for the relief of pressure in a body compartment or on a body part. Cranial Nerve Palsies is a group of surgical interventions performed in the vertebral column Vertebral column The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy with the goal of alleviating direct compression Compression Blunt Chest Trauma on the spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy.
Decompression techniques include:
Decompression techniques are classified as direct (permits visualization of the dural sac) and indirect (does not permit visualization of the dural sac).
Spinal instability is a contraindication for SCDS.
Spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy decompression surgery Decompression surgery A surgical operation for the relief of pressure in a body compartment or on a body part. Cranial Nerve Palsies is performed as a combination of different procedures according to the needs in each individual case. The following are among the most commonly performed decompression techniques.
Laminectomy (open approach):
Diskectomy (open approach):
These procedures may also be done in a minimally invasive fashion; however, such procedures are beyond the scope of this review.