FIG. 7.34 The nervous system. The brain and spinal cord (highlighted green) constitute the central nervous system (CNS), and the nerves (yellow) make up the peripheral nervous system (PNS). (From Patton KT, Thibodeau GA: The human body in health & disease, ed 6, St Louis, 2014, Mosby.)
VP (Ventriculoperitoneal) Shunt
• This procedure (see Fig. 7.38 for a detailed explanation) is performed to alleviate hydrocephalus.
• Two setups—one for craniotomy and the other for laparotomy—are required.
• The wound classification is class I (clean).
• The choroid plexus—located at the fourth, third, and lateral ventricles—produces cerebrospinal fluid (CSF).
• A burr hole is drilled in the occipital or parietal bone, and a ventricular catheter is inserted into the posterior part of the lateral ventricle.
Ulnar Nerve Transposition
• The procedure is indicated for the treatment of cubital tunnel syndrome.
• The nerve is moved to lie under the skin and fat but on top of, within, or under the muscle.
• The ulnar nerve is located behind the medial epicondyle.
• Regional anesthesia (Bier block) is used for this procedure.
• The wound category is class I (clean).
Transsphenoidal Hypophysectomy
Transsphenoidal hypophysectomy (Fig. 7.39) is the surgical removal of the hypophysis (the pituitary gland, also called the hypophysis) by way of the nose and sphenoidal sinus. It is usually performed in the treatment of tumors, most notably craniopharyngioma, but is also sometimes used in the treatment of Cushing syndrome caused by pituitary adenoma.
FIG. 7.35 A, Three-pin fixation skull clamp (Mayfield) for stabilizing head during neurosurgical procedures. B, Mayfield horseshoe headrest. (From Rothrock JC: Alexander’s care of the patient in surgery, ed 15, St Louis, 2015, Mosby.)
FIG. 7.36 Raney clip. (From Rosenfeld, JV, ed: Practical management of head and neck injury, ed 1, Sydney, 2012, Churchill Livingstone.)
• The pituitary gland’s location at the base of the cranium makes the nasal approach ideal: The sella (back wall of the sphenoid sinus), consisting of thin bone, lies over the pituitary and can easily be opened to provide access to it. Once the sella has been breached, the surgeon must cut through the dura, the tough inner lining of the skull, to reach the pituitary.
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