Neurosurgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Identify common neurosurgical conditions and indications for surgery.

2. Understand pathophysiology and clinical features of neurosurgical emergencies.

3. Recognize post-operative complications and nursing priorities.

4. Apply principles of neurosurgical patient care and monitoring.

 Key Glossary Terms

1. Traumatic Brain Injury (TBI)

• Definition: Structural or functional brain injury caused by external mechanical force.

• Types: Concussion, contusion, epidural hematoma, subdural hematoma, diffuse axonal injury

• Management: Stabilize airway, breathing, circulation; ICP monitoring; surgical evacuation if indicated

2. Intracranial Pressure (ICP)

• Definition: Pressure within the skull, normal 7–15 mmHg

• Causes of Raised ICP: TBI, tumors, hydrocephalus, hemorrhage

• Management: Head elevation, mannitol/hypertonic saline, surgical decompression

3. Hydrocephalus

• Definition: Accumulation of cerebrospinal fluid (CSF) causing ventricular dilation

• Types: Communicating vs non-communicating

• Management: Ventriculoperitoneal (VP) shunt, endoscopic third ventriculostomy (ETV)

4. Cranial Tumors

• Definition: Primary or secondary brain neoplasms

• Common Types: Gliomas, meningiomas, metastases

• Clinical Features: Headache, seizures, focal neurological deficits

• Management: Surgical resection, radiotherapy, chemotherapy

5. Spinal Surgery

• Indications: Spinal trauma, disc herniation, tumors, deformities

• Procedures: Laminectomy, discectomy, spinal fusion

• Complications: Neurological deficits, infection, CSF leak

6. Ventriculostomy / External Ventricular Drain (EVD)

• Definition: Catheter placed into the ventricles to drain CSF and monitor ICP

• Nursing Care: Monitor drainage, maintain sterility, measure ICP, prevent obstruction

7. Post-Operative Care

• Neurological Monitoring: GCS, pupil size/reactivity, limb movement

• ICP Management: Head elevation, monitor drains, medications to reduce swelling

• Seizure Precautions: Anticonvulsants, padded bed rails

• Infection Prevention: Aseptic technique for drains and wounds

8. Nursing & Medical Student Focus

• Nursing: Monitor neurological status, ICP, drainage, post-op vitals, patient/family education

• Medical Students: Identify indications for surgery, interpret imaging (CT, MRI), manage complications, plan perioperative care

9. Neurosurgery Mnemonics

• “CUSHING” for Raised ICP:

  • Change in consciousness

  • Unusual respiratory pattern

  • Systolic hypertension

  • Headache

  • Irregular pulse

  • Nausea/vomiting

  • Glucose monitoring

• “ABCDE” for Neuro Assessment:

  • Airway

  • Breathing

  • Circulation

  • Disability (GCS, pupils)

  • Exposure/environment

 Tables

Table 1: Common Neurosurgical Conditions

Table 2: Neurosurgical Post-Operative Nursing Care