LATEST NEUROLOGICAL SURGERY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF NEUROLOGICAL
SURGERY (ABNS) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 45-year-old male presents with a 3-month history
of progressive headache, nausea, and right-sided
weakness. MRI shows a 4 cm enhancing lesion in the
left frontal lobe with surrounding edema. What is the
most appropriate next step?
A) Stereotactic biopsy
B) Craniotomy for resection
C) Radiation therapy
D) Chemotherapy
Correct answer: B
Rationale: Single, accessible supratentorial lesion
with mass effect: maximal safe resection is indicated
for tissue diagnosis and cytoreduction. Biopsy if deep
or eloquent.
2. A 25-year-old male sustains a severe traumatic
brain injury (GCS 6) after a motor vehicle accident.
CT head shows a large acute subdural hematoma (15
,mm thickness) with 8 mm midline shift. What is the
most appropriate next step?
A) Emergency craniotomy for evacuation
B) Hyperventilation and mannitol
C) Intracranial pressure monitor only
D) Observation in ICU
Correct answer: A
Rationale: Acute subdural hematoma with thickness
>10 mm or midline shift >5 mm requires urgent
surgical evacuation.
3. A 60-year-old female presents with a 6-month
history of progressive gait disturbance, urinary
incontinence, and cognitive decline. MRI shows
ventriculomegaly with disproportionate enlargement
of the temporal horns. What is the most appropriate
next step?
A) Lumbar puncture with large-volume tap (30-50 mL)
B) Ventriculoperitoneal shunt
C) Endoscopic third ventriculostomy
D) Brain biopsy
Correct answer: A
,Rationale: Suspected normal pressure
hydrocephalus (NPH): large-volume lumbar puncture
(or external lumbar drainage) predicts shunt
response.
4. A 55-year-old male presents with a 3-week history
of severe bitemporal headache and visual field
defect. MRI shows a 2.5 cm pituitary macroadenoma
with suprasellar extension compressing the optic
chiasm. What is the most appropriate next step?
A) Transsphenoidal resection
B) Cabergoline (dopamine agonist)
C) Transcranial craniotomy
D) Radiation therapy
Correct answer: A
Rationale: Pituitary macroadenoma with visual
compromise requires surgical decompression
(transsphenoidal). Prolactinoma would respond to
cabergoline.
5. A 35-year-old male presents with a 2-year history
of seizures. MRI shows a 3 cm enhancing mass in the
right temporal lobe with a mural nodule and cyst.
What is the most likely diagnosis?
, A) Ganglioglioma
B) Glioblastoma multiforme
C) Metastasis
D) Meningioma
Correct answer: A
Rationale: Temporal lobe cystic lesion with
enhancing mural nodule in a young adult:
ganglioglioma (low-grade epilepsy-associated
tumor).
6. A 70-year-old male presents with a 2-month history
of progressive cervical myelopathy. MRI shows
cervical spondylosis with spinal cord compression at
C5-C6, severe stenosis with T2 hyperintensity within
the cord. What is the most appropriate next step?
A) Anterior cervical discectomy and fusion (ACDF)
B) Cervical laminectomy
C) Cervical laminoplasty
D) Conservative management (collar, physical
therapy)
Correct answer: A
Rationale: Myelopathy with cord signal change and
compression at 1-2 levels: ACDF is preferred for
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF NEUROLOGICAL
SURGERY (ABNS) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 45-year-old male presents with a 3-month history
of progressive headache, nausea, and right-sided
weakness. MRI shows a 4 cm enhancing lesion in the
left frontal lobe with surrounding edema. What is the
most appropriate next step?
A) Stereotactic biopsy
B) Craniotomy for resection
C) Radiation therapy
D) Chemotherapy
Correct answer: B
Rationale: Single, accessible supratentorial lesion
with mass effect: maximal safe resection is indicated
for tissue diagnosis and cytoreduction. Biopsy if deep
or eloquent.
2. A 25-year-old male sustains a severe traumatic
brain injury (GCS 6) after a motor vehicle accident.
CT head shows a large acute subdural hematoma (15
,mm thickness) with 8 mm midline shift. What is the
most appropriate next step?
A) Emergency craniotomy for evacuation
B) Hyperventilation and mannitol
C) Intracranial pressure monitor only
D) Observation in ICU
Correct answer: A
Rationale: Acute subdural hematoma with thickness
>10 mm or midline shift >5 mm requires urgent
surgical evacuation.
3. A 60-year-old female presents with a 6-month
history of progressive gait disturbance, urinary
incontinence, and cognitive decline. MRI shows
ventriculomegaly with disproportionate enlargement
of the temporal horns. What is the most appropriate
next step?
A) Lumbar puncture with large-volume tap (30-50 mL)
B) Ventriculoperitoneal shunt
C) Endoscopic third ventriculostomy
D) Brain biopsy
Correct answer: A
,Rationale: Suspected normal pressure
hydrocephalus (NPH): large-volume lumbar puncture
(or external lumbar drainage) predicts shunt
response.
4. A 55-year-old male presents with a 3-week history
of severe bitemporal headache and visual field
defect. MRI shows a 2.5 cm pituitary macroadenoma
with suprasellar extension compressing the optic
chiasm. What is the most appropriate next step?
A) Transsphenoidal resection
B) Cabergoline (dopamine agonist)
C) Transcranial craniotomy
D) Radiation therapy
Correct answer: A
Rationale: Pituitary macroadenoma with visual
compromise requires surgical decompression
(transsphenoidal). Prolactinoma would respond to
cabergoline.
5. A 35-year-old male presents with a 2-year history
of seizures. MRI shows a 3 cm enhancing mass in the
right temporal lobe with a mural nodule and cyst.
What is the most likely diagnosis?
, A) Ganglioglioma
B) Glioblastoma multiforme
C) Metastasis
D) Meningioma
Correct answer: A
Rationale: Temporal lobe cystic lesion with
enhancing mural nodule in a young adult:
ganglioglioma (low-grade epilepsy-associated
tumor).
6. A 70-year-old male presents with a 2-month history
of progressive cervical myelopathy. MRI shows
cervical spondylosis with spinal cord compression at
C5-C6, severe stenosis with T2 hyperintensity within
the cord. What is the most appropriate next step?
A) Anterior cervical discectomy and fusion (ACDF)
B) Cervical laminectomy
C) Cervical laminoplasty
D) Conservative management (collar, physical
therapy)
Correct answer: A
Rationale: Myelopathy with cord signal change and
compression at 1-2 levels: ACDF is preferred for
