PERIOP REPORTING NOTES: SURGICAL PROCEDURES

GROUP 1 NOTES

● Damage from ischemic strokes may

NEUROSURGERY not appear on CT scans for several
hours or days
DEFINITION ● CT angiography (CTA) can visualize
— The term “neurosurgery” is short for blood vessels in the head and neck
neurological surgery, a discipline that is
concerned with the diagnosis and treatment 3. EXTRACELLULAR BLEEDING
of nervous system disorders. Extracellular bleeding refers to hemorrhagic
— Most people think of neurosurgery as strokes, which can be categorized into three
brain surgery, but it is much more! It is the main types
medical specialty which is not only ● Subarachnoid hemorrhage (SAH)
concerned with diseases/disorders and ● Subdural hematoma (SDH)
injury affecting the brain but also with the ● Intraparenchymal cerebral
spinal cord, spinal column and peripheral hemorrhage (IPH or ICH)
nerves within all parts of the body. These conditions are considered medical
emergencies requiring immediate treatment
Common cases of problems related to
neurology and cerebrovascular issues: 4. Aneurysms
1. CEREBROVASCULAR DISEASE Aneurysms are balloon-like bulges in blood
Cerebrovascular disease encompasses vessels that can rupture and lead to
various disorders affecting blood flow in the bleeding
brain, including stroke ● Can be treated through various
● Includes conditions like carotid methods, including clipping, coiling,
stenosis, vertebral stenosis, and flow diversion
intracranial stenosis, aneurysms, ● Microsurgical and endovascular
and vascular malformations approaches are available for
● Can result from vessel narrowing, aneurysm treatment
clot formation, blockage, or blood ● Ruptured aneurysms causing
vessel rupture spontaneous intracranial
● Stroke is the fifth leading cause of hemorrhage are considered
death in the US and the leading emergencies
cause of adult disability
TAKE NOTE: If right side brain, left side of
2. INFARCT THROUGH CT SCANS the body will be weak
Infarcts can be detected through CT scans,
especially in cases of ischemic stroke SIGNS AND SYMPTOMS
Important considerations: Pre-surgery signs and symptoms
● CT scans are particularly useful for 1. Pain
identifying hemorrhagic strokes 2. Seizures
3. Dizziness and Vertigo
4. Visual disturbances

1
 PERIOP REPORTING NOTES: SURGICAL PROCEDURES
GROUP 1 NOTES
5. Muscle weakness blood tests that are used in neurosurgery
6. Abnormal sensation will vary depending on the individual case.
7. Slurred speech However, they all play an important role in
8. Changes in memory helping to diagnose and treat conditions
Post-surgery signs and symptoms affecting the nervous system.
1. Sickness and nausea, due to the
anesthetic. ● Complete Blood Count (CBC): To
2. Sore throat, due to the tube used assess overall blood health and
during surgery to regulate your identify any underlying infections or
breathing and oxygen levels. anemia.
3. Headaches, caused by swelling in ● Coagulation tests: measure your
your brain and the incision. blood's ability to clot, and how long it
4. Momentary dizziness takes to clot.
5. Difficulty swallowing
● Electrolytes: To measure levels of
6. Aphasia (difficulty speaking)
sodium, potassium, and other
7. Brain swelling
minerals in the blood.
8. Confusion or delirium
● Liver function tests: are blood tests
9. Movement or balance problems
10. Muscle weakness
used to help find the cause of your
symptoms and monitor liver disease
or damage.
LABS AND DIAGNOSTICS ● Kidney function tests: are urine or
1. Blood tests blood tests that evaluate how well
Blood tests are an important part of the your kidneys are working.
diagnostic process for neurosurgery. They
can help to rule out other causes of 2. CSF analysis
symptoms, and can provide information A lumbar puncture, also called a spinal tap,
about the level of inflammation present. is a diagnostic procedure used to collect
There are a number of different blood tests cerebrospinal fluid (CSF) for analysis. CSF
that can be used in neurosurgery. The most is the clear fluid that surrounds and protects
common are the white blood cell count the brain and spinal cord. A lumbar
(WBC) and the erythrocyte sedimentation puncture is performed by inserting a needle
rate (ESR). The WBC is a measure of the into the lower back to collect a small amount
level of inflammation present, and the ESR of CSF. CSF analysis can help diagnose
is a measure of the rate at which red blood various conditions, such as infections,
cells settle in a tube of blood. Other blood inflammation, tumors, and bleeding in or
tests that may be used include the around the brain. CSF can also be used to
C-reactive protein (CRP) test, which measure the pressure inside the skull. A
measures the level of CRP in the blood. lumbar puncture is generally safe and
CRP is a protein that is produced by the complications are rare.
liver in response to inflammation. The CRP
test can be used to monitor the level of 3. Imaging
inflammation present, and can also be used Imaging is critical in the evaluation of
to monitor the response to treatment. The patients with suspected neurosurgical

2
 PERIOP REPORTING NOTES: SURGICAL PROCEDURES
GROUP 1 NOTES
disorders. A variety of imaging modalities There are a number of special tests that
are available, each with its own advantages may be used to diagnose neurological
and disadvantages. conditions. These include:

CT Scans -Electroencephalography (EEG): This test

- the imaging modality of choice for measures electrical activity in the brain and
many neurosurgical disorders, as it can be used to diagnose conditions such as
provides excellent anatomical detail. epilepsy.
- It is particularly useful in determining
if there is bleeding in the brain, or -Evoked potentials: These tests measure
bony destruction in the spinal the brain’s response to stimuli and can be
column. used to diagnose conditions such as
multiple sclerosis.
MRI is often used for disorders that require
more detailed anatomical information, such -Magnetic resonance imaging (MRI): This
as tumors or vascular abnormalities. test uses magnetic fields and radio waves to
create images of the brain and can be used
PET and SPECT are useful for functional to diagnose conditions such as brain
imaging, and can be used to evaluate tumors.
cerebral metabolism or blood flow.
-Positron emission tomography (PET):
Angiography This test uses radioactive tracers to create
- is occasionally used to evaluate images of the brain and can be used to
vascular abnormalities. diagnose conditions such as Alzheimer’s
- This test involves injecting dye into disease.
the blood vessels of the brain and
then taking X-rays of these vessels. -Electromyography (EMG) and Nerve
Conduction Velocity (NCV): these tests
Myelography detect muscle and nerve dysfunction,
- is used to evaluate disorders of the respectively, helping diagnose
spinal cord, and can be performed conditions like peripheral neuropathy,
with CT or MRI.
where both muscle and nerve
- Some patients with implanted metal
involvement can be assessed.
devices cannot undergo MRI
scanning. In order to assess the
spinal cord in these patients, a
PRE-OPERATIVE ASSESSMENTS
special type of CT called a CT
1. Medical History and Physical
myelogram can be done.
Examination
● Medical History: Detailed review of
X-ray imaging is often useful in assessing
the patient's medical history,
the bones of the skull and spine.
including previous surgeries,
comorbid conditions (e.g., diabetes,
4. Special tests

3
 PERIOP REPORTING NOTES: SURGICAL PROCEDURES
GROUP 1 NOTES
hypertension), and any neurological ● Anticoagulants: Special attention to
symptoms. medications affecting blood clotting,
● Neurological Examination: which may need to be paused or
Assessment of neurological function managed differently.
to establish a baseline and identify
any deficits that may impact surgery 5. Patient Education and Consent
or recovery. ● Informed Consent: Detailed
discussion with the patient about the
2. Imaging and Diagnostic Tests procedure, risks, benefits, and
● Neuroimaging: MRI, CT scans, or expected outcomes. Ensuring the
other imaging modalities to visualize patient understands and agrees to
the brain or spinal cord and plan the the surgery.
surgical approach. ● Preoperative Instructions:
● Blood Tests: Routine blood tests to Providing guidance on fasting,
evaluate overall health, including medication adjustments, and what to
complete blood count (CBC), expect on the day of surgery.
electrolytes, liver and kidney
function, and coagulation profile. 6. Preoperative Optimization
● Blood Sugar Control: For diabetic
3. Preoperative Risk Assessment patients, ensuring blood glucose
● Cardiovascular Evaluation: levels are well managed.
Assessment of heart health, ● Preoperative Hygiene: Instructions
including ECG, echocardiogram, or on cleaning the surgical site and
stress tests if the patient has a possibly using antimicrobial
history of cardiac issues. solutions to reduce infection risk.
● Pulmonary Evaluation: Particularly ● Preoperative Physiotherapy: In
important for patients with some cases, preoperative
pre-existing lung conditions or those physiotherapy may be
undergoing extensive surgeries. recommended to improve recovery
● Anesthesia Assessment: outcomes.
Evaluation by an anesthesiologist to
assess risks related to anesthesia, 7. Psychological Evaluation
including airway management and ● Mental Health Assessment:
potential for complications. Evaluating the patient’s
psychological readiness and coping
4. Medication Review strategies. For some patients,
● Current Medications: Review of all preoperative counseling or support
medications, including may be beneficial.
over-the-counter drugs and
supplements. Some medications 8. Coordination of Care
may need to be adjusted or stopped ● Multidisciplinary Team:
before surgery. Coordination with other specialists
involved in the patient's care, such

4
 PERIOP REPORTING NOTES: SURGICAL PROCEDURES
GROUP 1 NOTES
as oncologists or endocrinologists, if managed through non-surgical
relevant. treatments.
● Logistics: Ensuring all preoperative ● Epilepsy Neurosurgery - Epilepsy
testing and evaluations are neurosurgery is for individuals with
completed and that there is a clear epilepsy. Specifically, this procedure
plan for postoperative care and is for those who have severe
rehabilitation. epileptic seizures and have not
found relief through non-surgical
treatments. Most often, neurologists
recommend medications to deal with
DIFFERENT PROCEDURES OF epilepsy and related seizures. If this
NEUROSURGERY does not work, however, epilepsy
● Craniotomy - Is a common neurosurgery may be needed, which
neurosurgery procedure that involves removing or modifying the
involves removing a part of the skull part of the brain that is producing
bone to allow for direct access to the severe and potentially fatal seizures.
brain. This is used to treat a variety ● Chiari Decompression - Is used to
of neurological concerns, including treat Arnold-Chiari malformation.
brain strokes. It is a potentially This condition produces an inability
life-saving procedure in many cases. to properly balance. Chiari
The removed portion of the skull is decompression involves removing a
eventually replaced to minimize the bone in the back of the skull to
visible long-term impact of the widen the foramen magnum. This, in
procedure. many cases, helps improve balance
● Decompressive craniectomy- and coordination.
Decompressive craniectomy is a ● Lumbar Puncture - A lumbar
surgical procedure in which a part of puncture, which is also called a
the skull is removed to relieve spinal tap, is one of the simpler (yet
pressure on the brain. This is still relatively complex) neurosurgery
typically done in cases of severe procedures. It is a diagnostic
brain swelling, often caused by procedure that is performed to
traumatic brain injury, stroke, or determine if the patient has signs of
other conditions that lead to any conditions related to the central
increased intracranial pressure. nervous system. It is overall a safe
● Anterior Cervical Discectomy - Is surgery when performed by an
a common neurosurgery procedure experienced neurologist, and the
that most notably treats herniated risks are minimal.
discs in the neck. The goal of the ● Biopsy- Biopsy is a procedure to
procedure is to remove the herniated remove a sample of abnormal tissue
disc to provide pain relief. This for examination under a microscope.
procedure is often recommended by The tissue cells taken during the
neurosurgeons when pain cannot be biopsy can show what kind of brain
lesion (abscess, tumor) is present

5
 PERIOP REPORTING NOTES: SURGICAL PROCEDURES
GROUP 1 NOTES
and whether it is benign (not or eliminate symptoms like pain,
cancerous) or cancerous numbness, or weakness in the arms
(malignant). Involves a pathologist or legs.
examining tissue samples for signs ● Endovascular surgery-
of diseases and the extent of their Endovascular surgery is minimally
progression. A pathologist is a invasive vascular surgery. Surgeons
specialist doctor who examines use tiny incisions to thread catheters
bodily tissues and fluids to provide to damaged blood vessels. They use
diagnoses that guide treatment endovascular surgery procedures to
decisions. remove blood clots and improve
● Functional neurosurgery- blood flow. Endovascular surgery
Functional neurosurgery is a can help reduce your risk of heart
neurosurgical procedure done for attack, stroke and other
alleviating symptoms of various life-threatening conditions.
central nervous system disorders ● Tumor embolization- Tumor
that do not have any gross embolization is a minimally invasive
anatomical abnormality. Functional procedure in which a small, thin tube
neurosurgery needs a (catheter) is guided into the feeding
well-coordinated multidisciplinary arteries of a tumor in order either to
team approach involving shut down the blood supply to the
neuroanesthesiologists, tumor or deliver tumor-killing therapy
neurologists, neurosurgeons, directly to the tumor.
neurophysiologists, and ● Endoscopic craniosynostosis
neuropsychologists. repair- Endoscopic craniosynostosis
Anesthesiologists face certain repair is a minimally invasive
unique challenges while managing surgical procedure used to treat
patients scheduled for functional craniosynostosis, a condition in
neurosurgery. which one or more of the sutures in
● Laminectomy- A laminectomy is a an infant's skull close prematurely,
type of surgical procedure that restricting the growth of the skull and
involves the removal of a portion of potentially leading to increased
the vertebra called the lamina. The intracranial pressure and abnormal
lamina is the back part of the head shape.Endoscopic
vertebra that covers and protects the craniosynostosis repair is a highly
spinal canal.The primary purpose of specialized procedure and is usually
a laminectomy is to relieve pressure performed by pediatric
on the spinal cord or nerves, which neurosurgeons in conjunction with
can be caused by conditions such as craniofacial surgeons.
spinal stenosis (narrowing of the ● Endoscopic endonasal surgery-
spinal canal), herniated discs, or Endoscopic endonasal surgery is a
tumors. By removing the lamina, the minimally invasive method that
surgeon creates more space within allows a surgeon to go through the
the spinal canal, which can reduce nose to operate on areas at the base

6
 PERIOP REPORTING NOTES: SURGICAL PROCEDURES
GROUP 1 NOTES
of the brain and the top of the 6. Neuromonitoring: Intracranial pressure
spine.Endoscopic endonasal surgery (ICP), cerebral blood flow, brain
can be used to remove tumors in oxygenation, electrophysiology, and
areas near the base of the brain or neuroimaging.
skull. It can also be used to remove
tumors at the top of the spine. It can Vital Signs Monitoring
also be used to treat problems with
the sinuses. This approach allows 1. Blood Pressure: Monitor for
the surgeon to reach these areas hypotension or hypertension, which
without the need for large incisions can indicate bleeding or stress
or removal of parts of the skull. This response.
often makes recovery quicker and 2. Heart Rate: Observe for tachycardia
less painful. or bradycardia, which may signal
complications.
3. Respiratory Rate and Oxygen
POST-OPERATIVE ASSESSMENTS Saturation: Ensure the patient
maintains adequate ventilation and
Neurological Assessment oxygenation, particularly if they have
undergone procedures affecting the
1. Consciousness Level: Assess the brainstem.
patient's level of consciousness 4. Temperature: Monitor for fever,
using the Glasgow Coma Scale which may indicate infection or other
(GCS). complications.
2. Pupillary Response: Evaluate the
size, shape, and reactivity of pupils Fluid and Electrolyte Management
to light. Non-reactive or unequal
1. Fluid Balance: Assess input and
pupils may indicate increased
output to prevent dehydration or fluid
intracranial pressure (ICP) or
overload, which can complicate
neurological compromise.
recovery.
3. Motor Function: Check for strength
2. Electrolyte Levels: Regularly check
and movement in all four limbs. Any
electrolytes to prevent imbalances
new weakness or inability to move
that could affect neurological
may suggest complications such as
function.
hematoma or stroke.
4. Sensory Function: Assess the Pain Assessment
patient's ability to feel touch and pain
in all extremities, which can indicate 1. Pain Assessment: Use appropriate
the integrity of sensory pathways. scales to evaluate pain levels and
5. Cranial Nerve Function: Perform a administer analgesics as needed.
quick examination of cranial nerves 2. Nausea and Vomiting: Monitor for
to identify any deficits that may arise postoperative nausea and vomiting,
postoperatively. which can complicate recovery and
may require antiemetic therapy.

7
 PERIOP REPORTING NOTES: SURGICAL PROCEDURES
GROUP 1 NOTES
Complication Surveillance sts-in-neurosurgery-the-best-at-dr-raos-
guntur/
1. Signs of Infection: Watch for fever,
increased white blood cell count, Panda, N. B., Mahajan, S., & Chauhan, R.
and localized signs of infection at the (2019). Management of postoperative
surgical site. neurosurgical patients. *Journal of
2. Neurological Deterioration: Be Neuroanaesthesiology and Critical Care*,
vigilant for any sudden changes in 6(2), 80–86.
neurological status, which may https://doi.org/10.1055/s-0039-1689055
indicate complications such as
hematoma or infection. Shine Hospitals. (2023). Neurological
3. Respiratory Complications: Disorders: Signs, Symptoms, and When to
Monitor for signs of respiratory Seek Help. Retrieved from
distress or failure, particularly in https://shinehospitals.in/neurological-disord
patients with pre-existing respiratory ers-signs-symptoms-help.php
conditions.
Hinkle, J., Cheever, K., & Overbaugh, K.
Specific Monitoring Techniques: (2022). Brunner & Suddarth’s Textbook of
Medical-Surgical Nursing. 15th Edition.
1. ICP monitoring: Intraventricular Wolters Kluwer
pressure monitoring (invasive) or
optic nerve sheath diameter Cleveland Clinic. (2023). Brain Surgery.
measurement (noninvasive). Retrieved from
2. Cerebral blood flow monitoring: https://my.clevelandclinic.org/health/tre
Transcranial Doppler (TCD) to atments/16802-brain-surgery
measure blood flow velocities and
other indices. Common neurological tests. (n.d.). NYU
3. Cerebral oxygenation monitoring: Langone Health.
Jugular venous oximetry, cerebral https://nyulangone.org/care-services/neuros
oximetry, or brain tissue urgery/common-neurological-tests
oxygenation.
4. Cerebral metabolism monitoring:
Cerebral microdialysis.

REFERENCES

Dr Rao’s Hospitals. (2023, October 21).

Diagnostic tests in Neurosurgery – the
best at Dr Raos, Guntur - Dr Rao’s
Hospitals. Dr Rao’s Hospitals - Act Fast
Save Brain and Spine.
https://drraoshospitals.com/diagnostic-te