The head bone connected to the neck bone…

1. The head bone connected to the neck bone…

2. N E U R O L O G I C A L S U R G E R Y PITUITARY GLAND

3. N E U R O L O G I C A L S U R G E R Y anterior pituitary secretes 6 important hormones Prolactin Adrenocorticotropic Hormone (ACTH) Thyroid Stimulating Hormone (TSH) Growth Hormone (GH) Luteinizing Hormone (LH) Follicle Stimulating Hormone (FSH) posterior pituitary secretes 2 important hormones Vasopressin, or antidiuretic hormone (ADH) Oxytocin

4. N E U R O L O G I C A L S U R G E R Y optic chiasm pituitary gland coronal schematic and MRI of the normal pituitary gland and its anatomic relationship to the optic apparatus

5. N E U R O L O G I C A L S U R G E R Y Pituitary tumors enlarge upwards and deform the optic chiasm

6. N E U R O L O G I C A L S U R G E R Y lesions along the optic nerve result in characteristic defects in the visual field a chiasmatic tumor (pituitary adenoma) can result in bitemporal hemianopsia

7. N E U R O L O G I C A L S U R G E R Y

8. N E U R O L O G I C A L S U R G E R Y Trans-Sphenoidal Hypophysectomy

9. N E U R O L O G I C A L S U R G E R Y The head bone connected to the neck bone,The neck bone connected to the back bone,The back bone connected to the thigh bone,The thigh bone connected to the knee bone, The knee bone connected to the leg bone,The leg bone connected to the foot bone… Dry Bones (composer unknown)

10. N E U R O L O G I C A L S U R G E R Y Edwin Smith Surgical Papyrus “Corrugations” of the Brain Brain “Membrane” enveloping the Brain “Fluid” in the Interior of the Head

11. N E U R O L O G I C A L S U R G E R Y Case Two Title: Instructions concerning a [gaping] wound [in his head], penetrating to the bone. Examination: If thou examinest a man having a [gaping] wound [in] his [head], penetrating to the bone, thou shouldst lay thy hand upon it (and) [thou shouldst] pal[pate hi]s [wound]. If thou findest his skull [uninjured, not hav]ing a perforation in it... Diagnosis: Thou shouldst say regarding [him]: “One hav[ing a gaping wou]nd in his head. An ailment which I will treat.” Treatment: [Thou] shouldst bind [fresh meat upon it the first day; thou shouldst apply for him two strips of linen, and treat afterward with grease, honey, (and) lin]t every day until he recovers

12. N E U R O L O G I C A L S U R G E R Y Case Six Title: Instructions concerning a gaping wound in his head, penetrating to the bone, smashing his skull, (and) rending open the brain of his skull. Examination: If thou examinest a man having a gaping wound in his head, penetrating to the bone, smashing his skull, (and) rending open the brain of his skull, thou shouldst palpate his wound. Shouldst thou find that smash which is in his skull [like] those corrugations which form in molten copper, (and) something therein throbbing (and) fluttering under thy fingers, like the weak place of an infant's crown before it becomes whole-when it has happened there is no throbbing (and) fluttering under thy fingers until the brain of his (the patient's) skull is rent open-(and) he discharges blood from both his nostrils, (and) he suffers with stiffness in his neck... Diagnosis: [Thou shouldst say concerning him]: "An ailment not to be treated." Treatment: Thou shouldst anoint that wound with grease. Thou shalt not bind it; thou shalt not apply two strips upon it: until thou knowest that he has reached a decisive point.

13. N E U R O L O G I C A L S U R G E R Y "...to calm if irritated,...to soften when firm,...to cool when hot,...to deflate when swollen, ...to relieve when painful." WARNING:Ancient medical texts are easily mistranslated and misinterpreted. DO NOT attempt to diagnose or treat ailments in the light of these texts!

14. N E U R O L O G I C A L S U R G E R Y Cerebral Spinal Fluid (CSF)

15. N E U R O L O G I C A L S U R G E R Y Hydrocephalus

16. N E U R O L O G I C A L S U R G E R Y Does hydrocephalus have to be treated? Pathology sample of a severely hydrocephalic brain Normal MRI (coronal) Absolutely!

17. N E U R O L O G I C A L S U R G E R Y

18. N E U R O L O G I C A L S U R G E R Y CSF resorption occurs at arachnoid granulations x obstructions typically occur at the Sylvian aqueduct

19. N E U R O L O G I C A L S U R G E R Y Anesthesia Short acting paralytics: succinylcholine Long acting paralytic: pancuronium H2 blockers: pepcid (famotidine) Benzodiaepines: valium (diazepam) Barbiturates: pentothal (sodium thiopental) The case is over – doc help me with the pain Narcotics Asparin vs tylenol

20. N E U R O L O G I C A L S U R G E R Y

21. N E U R O L O G I C A L S U R G E R Y trajectory for 3rd ventriculostomy x

22. N E U R O L O G I C A L S U R G E R Y Endoscopic 3rd Ventriculostomy

23. N E U R O L O G I C A L S U R G E R Y

24. N E U R O L O G I C A L S U R G E R Y Sequence of events during a 3rd Ventriculostomy

25. N E U R O L O G I C A L S U R G E R Y

26. N E U R O L O G I C A L S U R G E R Y If you’re going to make omelettes you have to break some eggs; if you’re going to do neurosurgery you have to crack some skulls…

27. N E U R O L O G I C A L S U R G E R Y Positioning

28. N E U R O L O G I C A L S U R G E R Y Bone Work

29. N E U R O L O G I C A L S U R G E R Y Dural Opening

30. N E U R O L O G I C A L S U R G E R Y Cortical Resection

31. legs arms head N E U R O L O G I C A L S U R G E R Y Homunculus

32. legs arms head N E U R O L O G I C A L S U R G E R Y

33. N E U R O L O G I C A L S U R G E R Y

34. N E U R O L O G I C A L S U R G E R Y News you can’t use Fun facts about sperm: less than 1 calorie 150 mg protien 11 mg carbohydrates 6 mg fat 3 mg cholesterol 7% US RDA potassium 3% US RDA copper 3% US RDA zinc

35. N E U R O L O G I C A L S U R G E R Y