MICHAEL THOMAS D.O.
EDUCATIONAL REQUIREMENTS FUNCTIONAL NEUROANATOMY NEUROPHYSIOLOGY NEUROPATHOLOGY NEUROPHARMACOLOGY NEUROANESTHESIOLOGY NEURORADIOLOGY NEUROONOCOLOGY NEUROTRAUMA PEDIATRIC NEUROSURGERY
TERMINOLOGY CRANIOTOMY- REMOVAL AND REPLACEMENT OF PART OF CRANIUM CRANIECTOMY- REMOVAL W/O REPLACEMENT OF PART OF CRANIUM LAMINOTOMY- REMOVAL OF PART OF LAMINA LAMINECTOMY- COMPLETE REMOVAL OF LAMINA BONE FLAP- THAT REGION OF CRANIUM REMOVED
SURGICAL MICROSCOPE LEICA OH3
MICROSCOPE TECHNOLOGY FLORESCENCE TECHNOLOGY FOR NEUROVASCULAR SURGERY
FLORESCENCE TECHNOLOGY
BRAIN LAB NEURONAVIGATION
MICROSCOPE TECHNOLOGY INTEGRATION WITH STEREOTACTIC NAVIGATION
TENSOR FIBER TRACT IMAGE
BRAIN LAB INTRAOPERATIVE MRI
BRAIN LAB WITH FUNCTIONAL MRI MAPPING
BRAIN LAB MAPPING AND FIBER TRACKING
FUNCTIONAL MRI
BRAIN LAB 3D RECONSTRUCTED IMAGE
NEUROENDOSCOPY VENTRICULAR ENDOSCOPY – PRIMARILY USED TO TREAT INTRAVENTRICULAR TUMORS AND HYDROCEPHALUS MAY BE USED TO ASSIST WITH DIFFICULT AND LIMITED OPERATIVE EXPOSURES -IE; ANEUYSM SURGERY, PITUITARY SURGERY ASSISTANCE WITH SPINAL SURGERY
ENDOSCOPE USED WITH NEURONAVIGATION
HYDROCEPHALUS OBSTRUCTIVE-BLOCKAGE WITHIN VENTRICULAR CSF PATHWAYS COMMUNICATING- BLOCKAGE OF ABSORBTION AT ARACHNOID VILLI
OBSTRUCTIVE HYDROCEPHALUS AQUEDUCTAL STENOSIS INTAVENTRICULAR TUMORS-IE; COLLOID CYSTS,DERMOIDS, SUBEPYNDYMOMAS. PINEAL TUMORS, CERREBELLAR MASSES, CEREBELLAR STROKES/HEMORRHAGE, BRAINSTEM TUMORS 4th VENTRICLE IS USUALLY NORMAL SIZE OR SMALL
HYDROCEPHALUS - CLINICAL PRESENTATION GAIT DISTURBANCE HEAD ACHE MEMORY DISTURBANCE LETHARGY URINARY INCONTINANCE
AQUEDUCTAL STENOSIS SUPRACEREBELLAR ARACHNOID CYST AQUEDUCT OF SYLVIUS 4th VENTRICLE (NORMAL SIZE)
AQUEDUCTAL STENOSIS CORONAL MRIOBSTRUCTIVE HYDROCEPHALUS
PINEAL TUMOR
BRAINSTEM GLIOMA ASTROCYTOMA
COLLOID CYST
3rd VENTRICULAR COLLOID CYST colloid
TREATMENT OF HYDROCEPHALUS CSF DIVERSION – NORMAL SIZE VENTRICLES HAS 25 CC’s OF CSF – TOTAL PRODUCTION OF CSF IS 500 -750 CC’s PER DAY OBSTRUCTIVE HYDRO-ENDOSCOPIC 3RD VENTRICULOSTOMY OR AQUEDUCTAL DILATATION AND STENTING. IF THIS FAILS THEN VP SHUNT COMMUNICATING HYDROCEPHALUSVENTRICULOPERITONEAL SHUNT (VENTRICULOATRIAL , VENTRICULOPLEURAL)
ENDOSCOPIC VIEW OF 3RD VENTRICULOSTOMY FORMATION
ENDOSCOPIC VIEW OF OSTOMY AND PREPONTINE CISTERN
3rd VENTRICAL EXPLORATION
BRAIN TUMORS MULTIPLE TYPES DEPENDING ON EMBRYOLOGICAL ORIGIN -ie; Astrocytoma derived from glial tissue origin METASTASTATIC(secondary) BRAIN TUMORS MOST COMMON ASTROCYTOMA MOST COMMON PRIMARY BRAIN TUMOR
BRAIN TUMOR CLINICAL PRESENTATION HEAD ACHES SEIZURES NAUSEA/VOMITING MENTAL STATUS CHANGES GAIT DISTURBANCE VISUAL DISTURBANCE NEUROLOGICAL DEFICIT DEPENDING ON LOCATION CEREBRAL HEMORRHAGE BRAIN HERNIATION
BRAIN TUMOR DIFFERENCIAL DIAGNOSIS CEREBRAL ABCESS STROKE PSEUDOTUMOR CEREBRI CEREBRITIS (PRE-ABCESS STAGE) ARTERIAL-VENOUS MALFORMATION MS HYDROCEPHALUS
BRAIN TUMOR WORK UP AND INITIAL TREATMENT DEXAMETHASONE- INITIAL 10 MG IV X 1 THEN FOLLOWED WITH 4-6 MG IV/PO q 6 hrs OBTAIN CT OR MRI WITH AND WITH OUT CONTRAST IF MASS IS PRESENT THEN RULE OUT ABCESS vs METASTATIC DISEASE IF ORIGIN OF TUMOR CANT BE DISCOVERED THEN CEREBRAL BIOPSY AND POSSIBLY RESECTION IS INDICATED
FALX MENINGIOMA
MENINGIOMA
ASTROCYTOMA
ANAPLASTIC ASTROCYTOMA
ANAPLASTIC ASTROCYTOMA HISTOPATHOLOGY
PILOCYTIC ASTROCYTOMA
GLIOBLASTOMA MULTIFORME
GLIOBLASTOMA MULTIFORME
GBM HISTOPATHOLOGY
SUBEPENDYMAL GIANT CELL ASTROCYTOMA
FRONTAL CRANIOTOMY
EXPOSURE OF RIGHT FRONTAL LOBE
PARTIAL FRONTAL LOBECTOMY FALX SUPERIOR SAGITAL SINUS PREMOTOR CORTEX
LATERAL VIEW ANTERIOR FRONTAL LOBECTOMY FALX CEREBRI CORONAL SUTRE TEMPORALIS MUSCLE
TRANSVENTRICULAR COLLOID CYST REMOVAL
SKULL BASE MENINGIOMA SAGITAL CORONAL AXIAL
SKULL BASE MENINGIOMA – POST OP MRI
STRUCTURES OF THE CAVERNOUS SINUS PITUITARY P SPHENOID SINUS S
PITUITARY MACROADENOMA
PITUITARY ADENOMA CLINICAL PRESENTATION HEADACHE BITEMPERAL HEMIANOPSIA APOPLEXY(RARE) SECRETING vs NON-SECRETING ENDOCRENOPATHIES –Cushings(ACTH) ACROMEGALY(GH),PANHYPOPITUITARY FREQUENTLY HAVE ELEVATED PROLACTIN LEVELS-(STALK EFFECT vs PROLACTINOMA SECRETING ADENOMA
PITUITARY SURGERY MOST COMMON APPROACH IS TRANSSPHENOIDAL GOALS OF SURGERY 1) PRESERVE VISION 2) CORRECT ENDOCRENOPATHY CAVERNOUS SINUS INVASION WILL REQUIRE POST OPERATIVE STEREOTACTIC RADIOSURGERY ,CONTINUED MEDICAL MANAGEMENT, OR BOTH CRANIOTOMY IS RARELY INDICATED
TRIGEMINAL NEUARALGIA ETIOLOGY REDUNDANT SUPERIOR CEREBELLAR ARTERY COMPRESSION SUPERIOR PETROSAL VEIN COMPRESSION POSTERIOR FOSSA TUMOR MULTIPLE SCLEROSIS (bilateral TN)
TRIGEMINAL NEURALGIA(AKA tic douloureux) PATHOPHYSIOLOGY SEVERE PAROXYSMAL LANCINATING PAIN LASTING ONLY A FEW SECONDS OFTEN TRIGGERED BY SENSORY STIMULI CONFINED TO THE DISTRIBUTION OF ONE OR MORE DIVISIONS OF THE TRIGEMINAL NERVE ON ONE SIDE OF THE FACE DUE TO EPHAPTIC TRANSMISSION IN TRIGEMINAL NERVE FROM LARGE DIAMETER MYLENATED A FIBERS TO POORLY MYLENATED A-DELTA AND C NOCICEPTIVE FIBERS EPHAPTIC - conduction of nerve impulse across point of lateral contact rather than at synapse
VENTRAL BRAIN/POSTERIOR FOSSA
RIGHT CEREBELLOPONTINE ANGLE
TRIGENINAL NEURALGIA - TX OPTIONS MEDICAL- TEGRETOL, NEURONTIN, DILANTIN PERCUTANEOUS RADIOFREQUENCY RHIZOTOMY PERCUTANEOUS GLYCEROL INJECTION PERCUTANEOUS TRIGEMINAL BALLON COMPRESSION MICROVASCULAR TRIGEMINAL DECOMPRESSION STEREOTACTIC RADIOSURGERY
TRIGEMINAL NEURALGIA MICROVASCULAR DECOMPRESSION
CN VII+VIII A.I.C.A. SUP. PET. V. CN V S.C.A. CEREBELLUM FLOCCULUS PONS CN IV
PONTOMEDULLAY JUNCTION DURA CEREBELLUM
SPINALCORD TUMORS: CLASSIFICATION EXTRADURAL-arise outside cord in vertebral body and epidural tissue(metastatic tumors most common) INTRADURAL EXTRAMEDULLARY-arise from leptomeninges or nerve roots. ie; meningiomas and neurofibromas INTRAMEDULLARY- primary and secondary tumors that destroy tracts and grey matter
INTRADURAL EXTRAMEDULLARY TUMOR CONUS TUMOR
CAUDAEQUINA EPENDYMOMA
CERVICAL MEDULLARY ANGIOMA
SYRINGOMYELIA ETIOLOGIES ARNOLD CHIARI MALFORMATION INTRAMEDULLARY MASS IDIOPATHIC HYDROCEPHALUS
INTRAMEDULLARY ASTROCYTOMA
MEDULLOBASTOMA
MEDULLOBLASTOMA HISTOPATHOLOGY
INTRADURAL EXTRAMEDULLARY T-1 WEIGHTED SAGITAL IMAGE OF A NEUROFIBROMA
CONTRAST ENHANCED T1 WEIGHTED AXIAL IMAGE OF NEUROFIBROMA SPINAL CORD
C-6 SCHWANNOMA RESECTION
C-6 NEUROFIBROMA RESECTION
SUBDURAL HEMATOMA
POST OP CRANIOTOMY
SUBARACHNOID HEMORRHAGE
ANEURYSMAL SUBARACHNOID HEMORRAGE SEVERE SUDDEN ONSET HEAD ACHE MAY CAUSE ACUTE HYDROCEPHALUS HUNT HESS GRADING SCALE 0-5 HIGH GRADE PTS REQUIRE VENTRICULOSTOMY 4 PERCENT RERUPTURE RATE WITHIN 24 HR REQUIRES ANGIOGRAM MAY PRESENT WITH NO NEURO DEFICIT TO FOCAL DEFICIT TO COMA 3rd OF PATIENTS DON’T EVEN MAKE IT TO HOSPITAL VASOSPASM CLINICALLY EFFECTS 30% NO SOONER THAN DAY 3 ,USUALLY AROUND DAY6-8 ICP MANAGEMENT
MANAGEMENT OF ANEURYSMS ANGIOGRAM TO DEFINE ANEURYSM ANATOMY IF GRADE 3 OR LOWER SURGICALLY CLIP OR COIL VENTRICULOSTOMY FOR HYDROCEPHALUS CALCIUM CHANNEL BLOCKER (NIMODIPINE)HELPS PREVENT VASOSPASM STEROIDS (DEXAMETHASONE) ANALGESIA TRIPLE “H” THERAPY
VASOSPASM TREATMENT EARLY SURGERY CANT TREAT SAFELY WITHOUT SECURING ANEURYSM TRIPLE “H” THERAPY HYPER VOLEMIA HYPERTENSION HEMODILUTION
CAROTID BIFERCATION ANEURYSM CT ANGIOGRAM
BASILAR ANEURYSM POSTERIOR CEREBRAL ARTERY
CTA BASILAR ANEURYSM
OCCIPITAL AVM
NEUROSURGICAL HORIZONS GENE THERAPY STEM CELL IMPLANTS IMMUNOTHERAPY NANOTECHNOLOGY ROBOTICS MOORE’S LAW NEURO - CYBERTECHNOLOGY
Calcification Inhibitors in CKD and Dialysis Patients
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