RECONSTRUCTING OUR PATIENT S LIVES WHAT THE NUMBERS REALLY MEAN FOR THE NEUROSURGICAL PATIENT
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1 RECONSTRUCTING OUR PATIENT S LIVES WHAT THE NUMBERS REALLY MEAN FOR THE NEUROSURGICAL PATIENT
2 In the beginning... Current Procedural Terminology 1966 International Classification of Diseases go back to the early 1800 s
3 NOt
4 I AM SOOO CONFUSED AND OVER THIS...
5 WHY WE DON T SEEM TO THINK ALIKE... Coders are yellow Surgeons are RED
6 Neurosurgery It s not that simple The making of a Neurosurgeon
7 How it all begins... First, Timmy is just plain born smart
8 Then, he s the smartest kid in the class
9 He graduates at the top of his class
10 UNDERGRAD, LOTS MORE BIOLOGY AND CHEMISTRY TO DO Not a lot of time for fun
11 FINALLY GET ACCEPTED INTO MED SCHOOL
12 WHY TIM CHOSE NEUROSURGERY It s way more fun than Internal Medicine!
13 The public s idea of the average Neurosurgeon
14 Then Tim slogs through 7 years of Residency...
15
16 SURVIVES HIS NS ATTENDINGS
17 Tim is finally on his own and they are all watching...
18 ok, he gets it now and by the way, it s doctor to you...
19 Timothy finally gets to operate all day long!
20 The pager never stops...
21 Oh man, and sometimes it goes on all night...
22 Doctor, can I just talk to you about this code?
23 (WTF), really, I m about to scrub in!!!!!
24 The dreaded QUERY Why they are not always politically correct in responding to your sense of urgency...
25
26 The Basics POSITIONING INSTRUMENTS IMAGING TYPES OF SURGERIES
27 POSITIONING
28 SUPINE ANTERIOR CERVICAL DISCECTOMY AND FUSION ODONTOID SCREW CRANIOTOMY/CRANIECTOMY/BURR HOLES ALIF/XLIF TRANSPHENOIDAL
29 SUPINE WITH MAYFIELD
30 SUPINE WITH MAYFIELD
31 SITTING WITH MAYFIELD POSTERIOR CERVICAL FORAMINOTOMY
32 PRONE ON FACE PILLOW THORACIC LUMBAR
33 POSTERIOR CERVICAL FUSION
34 PRONE ON WILSON FRAME
35 PRONE ON WILSON FRAME THORACIC AND LUMBAR DECOMPRESSIONS DISCECTOMIES
36 LATERAL IN PINS LATERAL CRANIOTOMY
37 LATERAL FOR LUMBAR FUSION XLIF (EXTREME LATERAL INTERBODY FUSION
38 XLIF IN ACTION L2-4 XLIF BETWEEN RIBS AND ILIAC CREST
39 JACKSON TABLE WITH TRACTION FOR ACDF
40 JACKSON WITH WILSON FRAME
41 JACKSON WITH BUMPY PADS
42 FLIPPING PATIENT ON JACKSON FRAME
43 FLIPPING ON JACKSON
44 HEAD FRAMES
45 HORSESHOE FRAME PRIMARILY FOR BURR HOLES FOR SDH
46 MAYFIELD
47 SUPINE WITH SHOULDER BUMP LATERAL OBLIQUE PREVENTS OVER ROTATION OF NECK THAT MIGHT IMPAIR INTRACRANIAL VENOUS RETURN
48 LEKSELL FRAME
49 LEKSELL FRAME PLACED IN PRE-OP
50 PATIENT IN LEKSELL FRAME
51 TOOLS OF THE TRADE
52 EARLY INSTRUMENTS
53 suctions
54 What we d rather be doing when we are suctioning
55 SURGICAL PICKUPS
56 THE BASIC INSTRUMENTS
57 KERRISONS FOR BITING BONE
58 PITUITARIES FOR GRABBING SOFT TISSUE
59 RONGEURS FOR BITING LARGE PIECES OF BONE
60 SCISSORS
61 CALIPERS
62 GELPIES
63 CEREBELLARS
64 VERSA-TRAC
65 SHADOWLINE CERVICAL RETRACTORS
66 USE IN ACDF S
67 CERVICAL SCREWS AND PLATES
68 CARLAN CRANK
69 MALLETS
70 COBBS
71 CURETTES
72 SIMPLE SET-UP
73 BUSY BACK TABLE
74 BUSIER BACKTABLE
75 OMG! REALLY? YOU RE KIDDING ME!
76 LUMBAR SCREWS
77 Aids to navigate our way Microscopes Flouroscopy Stereotactic frames Stealth navigation Cranial Spinal
78 Arms, Turkey feet and Trajectories BETTER TO SEE YOU WITH
79 Operating microscope
80
81
82 Arms of all sizes Flex arms (skinny) C-Arms (big) O-Arms (jumbo)
83 not the kind of arms we are talking about
84 Skinny arms
85 flex arms Used to secure tubes in place for minimally invasive surgery
86 Big Arms
87 C-Arms
88 Jumbo Arms
89 O-Arms
90 O-Arm opened up, getting in position
91 It s a big machine
92 taking the image, we have all left the room
93 Stealth for spinal instrumentation
94
95 Axial and sagittal views
96 placement of screws under steath guidance
97 Stereotactic biopsy frame
98 Applying the frame
99 Getting ready to get imaged
100 Final set-up, patient is awake
101 coming out of the frame
102 Stealth for craniotomy essentially gps
103 provides the trajectory
104
105 Herniated discs
106 Herniated Lumbar disc
107
108 Cephalad migration
109 Caudal migration
110
111 Cervical Stenosis
112
113 Critical Stenosis
114
115
116
117
118 ACDF The most common surgery for cervical stenosis
119
120
121
122 Cervical Corpectomy
123 Cervical Kyphosis posterior cervical
124 Posterior Cervical
125 Pulled out screws with kyphosis
126 Occipito-cervical fixation
127
128 360 degree fusion
129 Corpectomy
130 Giant Osteophyte
131 Cervical Disc Replacement
132 Odontoid Fractures
133 Odontoid Screws
134 Technically very difficult
135 Trigeminal Neuralgia Neurolysis with Glycerol GlyGlycerol
136 BACK PAIN
137 Lumbar stenosis patient
138
139 Lumbar stenosis
140
141 Spondylolisthesis
142
143
144 Minimally Invasive
145 MIS Incisions
146 Obviously NOT minimally invasive
147 Lumbar screws
148 Discitis
149
150
151 Compression fractures
152 BALLOON KYPHOPLASTY
153
154
155 Tumors Benign tumors Metastases Primary malignant tumors
156 Meningioma Sites
157 Meningiomas
158
159
160
161
162
163 Very large meningioma
164
165 Spinal Meningioma
166 METASTASES
167 Metastases
168
169
170
171
172
173
174 Cerebellar mets
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189 Intra-operative GBM
190 HEMATOMAS
191 Subdural Hematomas
192 Bleeding from bridging veins
193 Parafalcine ASDH Nonoperative Nonsurgical
194 Acute Subdural
195
196
197 Intra-op acute subdural
198
199 Chronic SDH
200 Chronic SDH with settling out
201
202
203
204
205 Famous good lookin guy with a subdural
206 Typical patient with a subdural hematoma
207 EpiduralEDH vs SDH
208
209 Epidural
210 Spinal EDH
211
212
213
214 Sub
215 worst Headache of life
216 Subarachnoid hemorrhage
217
218
219
220
221 Intraventricular hemorrhage
222
223
224
225
226 Angiogram
227 Hunt and Hess Scale
228 Fisher Scale
229 Fisher Scale Fisher scale
230
231 3D reconstruction
232 Circle of Willis
233
234 Hemorrhage due to AVM
235
236 Drugs that worsen bleeding
237 Intracranial hemorrhage
238 Enlarging Intracranial hemorrhage
239
240
241
242
243
244
245
246 Hemicraniectomy
247 Usually done for malignant cerebral edema
248
249 Hemorrhage with edema
250
251
252
253
254 Flap in the belly
255 Fixing the defect
256 Urban Cranial fixation
257 Cranial fixation plates and mesh
258
259
260
261
262
263
264 Is my head too big?
265 Deformed skull from HCP
266
267 Hydrocephalus
268 VP Shunt
269
270
271 Shunt valves
272
273 Reprogramming VPS
274 Peritoneal incision
275 Shunt problems
276 deep brain stimulation
277
278
279
280 The Battery Pack
281 O OCD and Depression
282 WOUNDSWOUNDS
283 the trauma room
284
285
286
287
288 GSW to the spine
289 open comminuted fx
290
291
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