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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