NEET SS Neurosurgery (MCh) Syllabus

Neurosurgery (MCh) syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Neurosurgery (MCh) in NEET SS, not a summary of it.

1. 1

   Neurotrauma and Neurocritical Care

   3 topics

   • Traumatic Brain Injury
     • Glasgow Coma Scale and severity grading
     • Intracranial pressure management
     • Traumatic hematomas (EDH, SDH, contusion)
   • Spinal Trauma
     • Spinal cord injury syndromes
     • Cervical and thoracolumbar fractures
   • Neurocritical Care
     • Cerebral edema and herniation syndromes
2. 2

   Neuro-oncology

   3 topics

   • Intra-axial Brain Tumors
     • Gliomas and WHO grading
     • Metastatic brain tumors
   • Extra-axial and Skull Base Tumors
     • Meningiomas and vestibular schwannoma
     • Pituitary and sellar lesions
   • Spinal Tumors
     • Intramedullary and extramedullary tumors
3. 3

   Cerebrovascular Neurosurgery

   3 topics

   • Intracranial Aneurysms
     • Clipping vs endovascular coiling
   • Vascular Malformations
     • AVM and cavernous malformations
   • Hypertensive and Spontaneous Hemorrhage
     • Surgical indications
4. 4

   Spinal, Pediatric and Functional Neurosurgery

   3 topics

   • Degenerative Spine Disease
     • Disc prolapse and spinal stenosis
     • Spinal instrumentation and fusion
   • Pediatric Neurosurgery
     • Hydrocephalus and CSF shunts
     • Neural tube defects and craniosynostosis
   • Functional Neurosurgery
     • Epilepsy and movement disorder surgery
     • Trigeminal neuralgia and pain procedures

Neurosurgery (MCh) flashcards for NEET SS

24 of 50 cards from the Neurosurgery (MCh) deck — real questions with worked answers.

1. What is the formula for Cerebral Perfusion Pressure (CPP), and what is the generally recommended target range in adult traumatic brain injury?

   CPP = MAP - ICP (mean arterial pressure minus intracranial pressure). Target CPP in adult TBI is 60-70 mmHg; avoid aggressive elevation >70 mmHg with fluids/pressors due to risk of ARDS.

2. State the three components of the Monro-Kellie doctrine and its core principle.

   The cranial vault is fixed and contains brain parenchyma (~80%), blood (~10%), and CSF (~10%). An increase in any one compartment must be offset by a decrease in another, or ICP rises. Initial compensation is via CSF and venous blood displacement.

3. List the three components and score ranges of the Glasgow Coma Scale (GCS), and the GCS cut-off defining severe head injury.

   Eye opening (1-4), Verbal response (1-5), Motor response (1-6); total 3-15. Severe head injury = GCS 3-8; moderate = 9-12; mild = 13-15.

4. On CT, how do you distinguish an epidural hematoma from a subdural hematoma in shape and dural relationship?

   Epidural hematoma: biconvex/lentiform, does NOT cross suture lines (limited by sutures), typically arterial (middle meningeal artery), often with a lucid interval. Subdural hematoma: crescentic, crosses sutures but not dural reflections, usually venous (bridging veins).

5. What is the Cushing triad and what does it indicate?

   Hypertension (widened pulse pressure), bradycardia, and irregular respirations. It is a late sign of raised intracranial pressure and impending brainstem herniation.

6. What is a diffuse axonal injury (DAI) and at which three anatomical sites does it characteristically occur?

   DAI is shearing injury to axons from rotational/acceleration-deceleration forces. Classic sites: grey-white matter junction, corpus callosum (especially splenium), and the dorsolateral rostral brainstem. MRI (GRE/SWI) is more sensitive than CT.

7. In TBI management, what ICP threshold warrants treatment, and what are the first-tier osmotic agents?

   Treat ICP sustained >22 mmHg (per BTF guidelines). First-tier osmotherapy: mannitol (0.25-1 g/kg) or hypertonic saline (e.g., 3% or 23.4%). Mannitol is contraindicated in hypovolemia/renal failure; serum osmolality kept <320 mOsm/L.

8. What is the SLIC (Subaxial Cervical Spine Injury Classification) and what score thresholds guide management?

   SLIC scores injury morphology (0-4), disco-ligamentous complex integrity (0-2), and neurologic status (0-3). Score <4 = nonoperative; =4 = surgeon's discretion; >4 = operative.

9. Define spinal shock versus neurogenic shock.

   Spinal shock = transient loss of all reflexes/flaccidity below the level of injury (resolution heralded by return of bulbocavernosus reflex). Neurogenic shock = hemodynamic state of hypotension with bradycardia from loss of sympathetic tone in injuries above T6.

10. Describe the clinical features of central cord syndrome.

    Most common incomplete cord syndrome; typically in elderly with cervical spondylosis after hyperextension. Disproportionately greater weakness in the upper limbs than lower limbs, with variable sensory loss and bladder dysfunction. Generally favorable prognosis.

11. Contrast anterior cord syndrome and Brown-Séquard syndrome in terms of deficits.

    Anterior cord syndrome: loss of motor function and pain/temperature below the lesion, with preserved proprioception/vibration (dorsal columns spared); poor prognosis. Brown-Séquard (hemisection): ipsilateral motor and proprioception loss, contralateral pain/temperature loss.

12. What does the ASIA Impairment Scale grade A signify, and what defines a complete spinal cord injury?

    ASIA A = complete injury: no motor or sensory function preserved in the lowest sacral segments (S4-S5), i.e., no sacral sparing. Sacral sparing (perianal sensation, voluntary anal contraction, deep anal pressure) indicates an incomplete injury.

13. What is the role and recommended timing of decompressive surgery in acute traumatic spinal cord injury?

    Early surgical decompression (within 24 hours of injury) is associated with improved neurological outcomes (e.g., STASCIS trial). It relieves ongoing cord compression to limit secondary injury.

14. In neurocritical care, what is the recommended PaCO2 target, and why is prophylactic hyperventilation avoided in TBI?

    Maintain normocapnia (PaCO2 35-40 mmHg). Prophylactic hyperventilation (PaCO2 <25 mmHg) causes cerebral vasoconstriction and ischemia; brief hyperventilation is reserved as a temporizing measure for acute herniation only.

15. What are the cardinal cardiopulmonary and electrolyte complications of aneurysmal subarachnoid hemorrhage to monitor in the ICU?

    Neurogenic stunned myocardium (Takotsubo, troponin elevation), neurogenic pulmonary edema, ECG changes, and cerebral salt wasting (hyponatremia with volume depletion) versus SIADH. Hyponatremia is the most common electrolyte disturbance.

16. State the diagnostic criteria categories for brain death in adults.

    Prerequisites: known irreversible cause, no confounders (hypothermia, drugs, metabolic). Findings: coma, absent brainstem reflexes (pupillary, corneal, oculocephalic, oculovestibular, gag, cough), and a positive apnea test (no respiratory effort with PaCO2 rise =60 mmHg or =20 above baseline).

17. What is the most common primary malignant brain tumor in adults, and what molecular markers define its classification and prognosis?

    Glioblastoma (IDH-wildtype, WHO grade 4). Key markers: IDH mutation status (wildtype = primary GBM, worse), MGMT promoter methylation (predicts temozolomide response/better prognosis), and 1p/19q for oligodendroglioma differentiation.

18. What defines an oligodendroglioma at the molecular level per the WHO 2021 classification?

    Oligodendroglioma requires both IDH mutation AND 1p/19q codeletion. It carries a relatively favorable prognosis and characteristically shows a 'fried egg' cell appearance and 'chicken-wire' vasculature on histology.

19. What is the Stupp protocol for glioblastoma?

    Maximal safe surgical resection followed by concurrent radiotherapy (60 Gy) with daily temozolomide, then 6 cycles of adjuvant temozolomide. Median survival is approximately 14-16 months.

20. Which tumor is the most common in the pediatric posterior fossa, and what are its key features?

    Pilocytic astrocytoma (WHO grade 1) is the most common pediatric posterior fossa/cerebellar tumor overall; medulloblastoma is the most common malignant one. Pilocytic astrocytoma shows Rosenthal fibers and a cyst-with-mural-nodule appearance; has BRAF (KIAA1549) fusion; excellent prognosis after resection.

21. What is the most common extra-axial intracranial tumor in adults, and how does it typically appear on imaging?

    Meningioma. It is dural-based, extra-axial, homogeneously enhancing with a characteristic 'dural tail' sign, and may show calcification and adjacent hyperostosis. Most are WHO grade 1 and benign.

22. Describe the typical clinical and imaging features of a vestibular schwannoma (acoustic neuroma).

    Arises from the vestibular division of CN VIII at the cerebellopontine angle. Presents with unilateral sensorineural hearing loss, tinnitus, and imbalance. MRI shows an enhancing 'ice-cream cone' mass widening the internal auditory canal. Associated with NF2 when bilateral.

23. What is the Simpson grading system used for, and what does Grade I represent?

    Simpson grade describes the extent of meningioma resection and predicts recurrence. Grade I = complete removal of tumor with its dural attachment and any abnormal bone/sinus (lowest recurrence). Grades increase with progressively less complete resection.

24. What is the most common location and histology of spinal cord tumors by compartment (extradural, intradural-extramedullary, intramedullary)?

    Extradural: metastases (most common spinal tumors overall). Intradural-extramedullary: meningiomas and schwannomas (nerve sheath tumors). Intramedullary: ependymomas (most common in adults) and astrocytomas (more common in children).

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