NEURO SURGICAL PROCEDURE 2 Burr hole

Burr Hole

Objective

In cases of well localized lesion, e.g. tumors, abscess and extradural subdural blood collection.

•   Drainage of collected fluid

•   Obtaining biopsy material.

Position

Supine, lateral or prone.

Anesthesia

Local.

Procedure

1.  Upto exposure of dura same as ventriculography.

2.  Extra and subdural hematoma drained but may require an extension to craniotomy.

3.  Abscess cysts and tumor sought with fine needle.

4.  Abscess and cysts aspirated and drained.

5.  Tumor aspirated and material smeared on slides.

Instruments

•   As for ventriculography

•   Glass microscope slides, 7. 6 cm × 2. 5 cm (3 in × 1 in)

•   In cases of brain abscess a selection of short rubber tubing of medium bore, 5 cm long will be required: also antibiotic solution.

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NEURO SURGICAL Procedures ventriculography

Ventriculography

Objective

To study the distortions of the ventricular system due to disease:

•   By injection of radio-opaque contrast medium.

Position

Supine.

Anesthesia

Local.

Procedure

1.  Incision 1.5 inches from midline in parietal area.

2.  Make a burr hole.

3.  Dura incised.

4.  Insert cannula measure pressure.

5.  Inject radio-opaque material.

Instruments

•   Sponge-holding forceps (Rampley), 2

•   Scalpel handle No. 4 with No. 22 blade (Bard Parker)

•   Scalpel handle No. 5 with No. 15 or 11 blade (Bard Parker)

•   Fine dissecting forceps, toothed (Gillies)

•   Medium dissecting forceps, non-toothed

•   Medium dissecting forceps, toothed (Lane’s)

•   Artery forceps, straight (Moynihan), 5

•   Scissors, stitch

•   Scissors curved (Metzenbaum)

•   Scissors curved (Strabismus)

•   Scissors straight (Iris)

•   Dura hooks, sharp and blunt

•   Periosteal elevator (Adson)

•   Dissector (McDonald) small aneurysm needle

•   Dura separator (Sergeant’s)

•   Dressing forceps (Tilley or Olivecrona)

•   Bone nibblers, curved on flat and angled on side, 2

•   Skull brace (Hudson)

•   Skull perforators and burrs (Hudson)

•   Retractors, self-retaining

•   Fine needle holder

•   Diathermy leads, electrodes, scabbard and lead anchoring forceps

•   Spinal manometer

•   CSF specimen bottles

•   10 ml syringe

•   Bonney’s blue

•   Steel rule and skin pen

•   Ventricular cannula

•   Towel clips, 5

•   Irrigation syringe

•   Pint measure with warm saline

•   Local anesthesia requisites

•   Suction tubing, fine nozzles and tube anchoring forceps

•   Fine Nelaton catheters, polyvinyl or latex rubber with spigots, 5.

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ENT Procedure 17 subandiblar gland excision

Excision of the Submaxillary (Submandibular) Gland

Objective

In cases of sialadenitis:

•   Excision of the submaxillary gland.

Position

Supine.

Anesthesia

General.

Procedure

1.  Transverse incision over the gland.

2.  Structures to be proteced are the mandibular branch of the facial nerve, the lingual nerve and hypoglossal nerve.

3.  The anterior facial vein is divided.

4.  The gland is dissected free of surrounding tissues.

5.  The facial artery is ligated.

6.  Wharton’s duct is identified adjacent to the lingual nerve, ligated and divided.

7.  Wound is closed in layers.

8.  A closed suction drain is employed.

Instruments

•   Plastic procedures set

•   Extra mosquito clamps   6

•   Lacrimal duct probes available

•   Basin set

•   Suction tubing

•   Blades (2) No. 15

•   Needle magnet or counter

•   Dissectors (e.g. peanut)

•   Drainage unit (e.g. Hemovac)

•   Bulb syringe

•    Nerve stimulator (locator)(optional)

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ENT Procedure 16 radical neck dissection

Radial Neck Dissection

Objective

In cases of cancer of head and neck:

•   Excision of cervical lymph node and adjacent muscular and vascular structures.

Position

Supine.

Anesthesia

General.

Procedure

   1.  Incision (Y, double, T, parelle-transverse, Z) in the lateral neck usually beneath the jaw to the supraclavicular region.

   2.  Skin flaps are mobilized.

   3.  The external jugular vein is severed.

   4.  The deep cervical fascia is incised (including some cuta­neous nerve branches).

   5.  The sternoclavicle origins of the sternomastoid muscle are divided.

   6.  The internal jugular vein is isolated and divided.

   7.  The omohyoid muscle is transected.

   8.  Fatty tissues bearing lymph nodes are dissected from underlying structures in continuity.

   9.  The insertion of the sternomastoid muscle is divided.

10.  The lower pole of the parotid gland removed, no injury to branches of the facial nerve.

11.  The facial artery and vein are divided, and the submaxillary gland and proximal end of the internal jugular vein are divided.

12.  The tissue bloc is then excised.

13.  The accessory nerve is preserved on the left, the thoracic duct is protected.

14.  The flaps are closed over suction drains.

15.  A moderate pressure dressing is applied.

Instruments

•   Minor procedure set

•   Thyroid set

•   Tracheostomy set

•   Extra mosquito clamps (24)

•   Extra towel clips (8)

•   Right angle clamps (finely pointed)

•   Basin set

•   Marking pen

•   Suction tubing

•   Blades (2) No. 10 (3) No. 15

•   Dissector (e.g. peanut)

•   Bulb syringe (2)

•   Umbilical tapes, vessel loops

•   Nerve stimulator (locator)

•   Suction drainage unit (e.g. Hemovac).

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew
Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

Also available now on android & smartphones same internet address.