General NeuroSurgery

Q) External ventricular drain are placed ?
A lateral ventricle
B 3rd ventricle
C 4th ventricle

D subarachnoid space

Q2) All of the following are true about Aneurysmal SAH except?
A Rebleed risk of 4 percent in first 24 hours
B Overall survival 50 percent
C Medical management includes Nimodipine every 4 hourly
D Rebleeding may occur after clipping of aneurysms

Answer D
Rebleeding usually occurs after coiling more than clipping of aneurysms. Hence a surveillance is advised after endovascular coiling

Q3. All of the following about brain tumors are true except?
A. Bilateral acoustic neuromas are seen in NF2
B. Supratentorial tumours are common in neonates
C. Meningioma recurs at a rate of 10% at ten years for subtotal excision
D. 15% of brain metastases are from breast primary

Ans is c

Neonates develop predominantly neuroectodermal tumours in supratentorial locations:
● teratoma;
● primitive neuroectodermal tumour (PNET);
● high-grade astrocytoma;
● choroid plexus papilloma/carcinoma

Q) A 36-year-old woman presents with amenorrhea, galactorrhea, and headache. MRI shows a 1.8 cm pituitary mass consistent with a prolactinoma. Serum prolactin is elevated. What is the most appropriate initial management?

A. Transcranial resection of the tumor
B. Transsphenoidal surgical decompression
C. Cabergoline therapy
D. Radiotherapy

C. Cabergoline therapy

Explanation:

Cabergoline, a dopamine agonist, is first-line therapy for prolactinomas, even macroadenomas, due to its efficacy in reducing both prolactin levels and tumor size.
It is preferred over bromocriptine because of its better side-effect profile.
Surgery is reserved for resistant tumors (those with persistent mass effect or hormonal dysfunction despite adequate medical therapy).
Transsphenoidal surgery is the standard surgical approach if needed, but not first-line here.
Radiotherapy and corticosteroids are not appropriate initial treatments for prolactinomas.

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