Investigations in Neurosurgery Dr. Ari Sami Neurosurgeon College of Medicine University of Sulaimani
Skull X-rays <ul><li>Standard views: </li></ul><ul><ul><li>Lateral </li></ul></ul><ul><ul><li>Postero-anterior </li></ul><...
Computed tomography (CT) scanning <ul><li>A pencil beam of X-ray traverses the patient's head and a diametrically opposed ...
 
What are some common uses of the procedure? <ul><li>CT scanning of the head is typically used to detect: </li></ul><ul><li...
CT scanning is also performed to: <ul><li>evaluate the extent of bone and soft tissue damage in patients with facial traum...
 
 
Interpretation of the cranial CT <ul><li>Ventricular system: size, position, compression </li></ul><ul><li>Width of cortic...
Magnetic Resonance Imaging (MRI)
 
Advantages <ul><li>Can select any plane, e.g. coronal, sagittal, oblique. </li></ul><ul><li>No ionizing radiation. </li></...
Disadvantages   <ul><li>Limited slice thickness-3mm. </li></ul><ul><li>Bone imaging limited to display of marrow. </li></u...
MR angiography <ul><li>Rapidly flowing protons can create different intensities and by a special sequence can demonstrate ...
MRI <ul><li>Diffusion-weighted MRI </li></ul><ul><li>Perfusion-weighted MRI </li></ul><ul><li>Functional MRI </li></ul><ul...
Ultrasound <ul><li>Extracranial: Doppler, colour doppler </li></ul><ul><li>Intracranial-transcranial doppler ultrasound: <...
Angiography  <ul><li>DSA: subtraction of a pre-injection film from the angiogram eliminates bone densities and improves ve...
Interventional angiography <ul><li>Embolization </li></ul><ul><ul><li>Particles (ivalon sponge) </li></ul></ul><ul><ul><li...
Radionuclide imaging <ul><li>Single photon emission computed tomography (SPECT): </li></ul><ul><ul><li>Uses compounds labe...
Radionuclide imaging <ul><li>Positron emission tomography (PET): </li></ul><ul><ul><li>Utilises positron-emitting isotopes...
Lumbar puncture <ul><li>CSF analysis </li></ul><ul><li>CSF drainage and pressure reduction </li></ul><ul><li>Avoid LP: </l...
Myelography
Others   <ul><li>EEG </li></ul><ul><li>Evoked potentials: </li></ul><ul><ul><li>Visual </li></ul></ul><ul><ul><li>Auditory...
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Surgery 5th year, 1st/part two & 2nd/part one lectures (Dr. Ari Sami)

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The lecture has been given on Dec. 2nd & 9th, 2010 by Dr. Ari Sami.

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Surgery 5th year, 1st/part two & 2nd/part one lectures (Dr. Ari Sami)

  1. 1. Investigations in Neurosurgery Dr. Ari Sami Neurosurgeon College of Medicine University of Sulaimani
  2. 2. Skull X-rays <ul><li>Standard views: </li></ul><ul><ul><li>Lateral </li></ul></ul><ul><ul><li>Postero-anterior </li></ul></ul><ul><ul><li>Towne`s (fronto-occipital) </li></ul></ul><ul><li>Look for: </li></ul><ul><ul><li>Fractures </li></ul></ul><ul><ul><li>Bone erosion: focal( pituitary fossa) </li></ul></ul><ul><ul><li>generalized (Multiple myeloma) </li></ul></ul><ul><ul><li>Bone hyperostosis: focal (Meningioma), generalized (Paget`s disease) </li></ul></ul><ul><ul><li>Abnormal calcification: tumors (meningioma), aneurysmal wall </li></ul></ul><ul><ul><li>Midline shift of pineal body </li></ul></ul><ul><ul><li>Signs of increased intracranial pressure </li></ul></ul><ul><ul><li>Configuration: platybasia, basilar impression </li></ul></ul>
  3. 3. Computed tomography (CT) scanning <ul><li>A pencil beam of X-ray traverses the patient's head and a diametrically opposed detector measures the extent of its absorption. </li></ul><ul><li>Determination of absorption values for multiple small blocks (voxels) </li></ul><ul><li>Reconstruction of these areas on a two-dimensional display (pixels) provides the characteristic CT scan appearance </li></ul>
  4. 5. What are some common uses of the procedure? <ul><li>CT scanning of the head is typically used to detect: </li></ul><ul><li>bleeding, brain injury and skull fractures in patients with head injuries. </li></ul><ul><li>bleeding caused by a ruptured or leaking aneurysm in a patient with a sudden severe headache. </li></ul><ul><li>a blood clot or bleeding within the brain shortly after a patient exhibits symptoms of a stroke. </li></ul><ul><li>a stroke, especially with a new technique called Perfusion CT. </li></ul><ul><li>brain tumors. </li></ul><ul><li>enlarged brain cavities (ventricles) in patients with hydrocephalus . </li></ul><ul><li>diseases or malformations of the skull. </li></ul>
  5. 6. CT scanning is also performed to: <ul><li>evaluate the extent of bone and soft tissue damage in patients with facial trauma, and planning surgical reconstruction. </li></ul><ul><li>diagnose diseases of the temporal bone on the side of the skull, which may be causing hearing problems. </li></ul><ul><li>determine whether inflammation or other changes are present in the paranasal sinuses. </li></ul><ul><li>plan radiation therapy for cancer of the brain or other tissues. </li></ul><ul><li>guide the passage of a needle used to obtain a tissue sample ( biopsy ) from the brain. </li></ul><ul><li>assess aneurysms or arteriovenous malformations through a technique called CT angiography </li></ul>
  6. 9. Interpretation of the cranial CT <ul><li>Ventricular system: size, position, compression </li></ul><ul><li>Width of cortical sulci and sylvian fissure: </li></ul><ul><li>Skull base and vault: hyperostosis, osteolytic lesion, remodelling, depressed fracture </li></ul><ul><li>Multiple lesions: tumor, abscesses, granuloma, infarction, trauma </li></ul><ul><li>Abnormal tissue density: </li></ul><ul><ul><li>Midline shift </li></ul></ul><ul><ul><li>Ventricular compression </li></ul></ul><ul><ul><li>Obliteration of the basal cisterns, sulci </li></ul></ul><ul><ul><li>High density( blood, calcification in tumor or AVM or hamertoma) </li></ul></ul><ul><ul><li>Low (infarction, tumor, abscess, oedema, encephalitis, resolving hematoma) </li></ul></ul><ul><ul><li>Mixed (tumor, abscess, AVM, contusion, hemorrahgic infarct) </li></ul></ul>
  7. 10. Magnetic Resonance Imaging (MRI)
  8. 12. Advantages <ul><li>Can select any plane, e.g. coronal, sagittal, oblique. </li></ul><ul><li>No ionizing radiation. </li></ul><ul><li>More sensitive to tissue changes, e.g. demyelination plaques. </li></ul><ul><li>No bone artifacts, e.g. intracanalicular acoustic neuroma </li></ul>
  9. 13. Disadvantages <ul><li>Limited slice thickness-3mm. </li></ul><ul><li>Bone imaging limited to display of marrow. </li></ul><ul><li>Claustrophobia. </li></ul><ul><li>Cannot use with pacemaker or ferromagnetic implant. </li></ul>
  10. 14. MR angiography <ul><li>Rapidly flowing protons can create different intensities and by a special sequence can demonstrate vessels, aneurysms, and AVM </li></ul>
  11. 15. MRI <ul><li>Diffusion-weighted MRI </li></ul><ul><li>Perfusion-weighted MRI </li></ul><ul><li>Functional MRI </li></ul><ul><li>MR spectroscopy (N-acetylaspartate, lactate,ATP, and inorganic phosphate) </li></ul>
  12. 16. Ultrasound <ul><li>Extracranial: Doppler, colour doppler </li></ul><ul><li>Intracranial-transcranial doppler ultrasound: </li></ul><ul><ul><li>Assessment of intracranial hemodynamics </li></ul></ul><ul><ul><li>Detection of vasospasm in SAH </li></ul></ul>
  13. 17. Angiography <ul><li>DSA: subtraction of a pre-injection film from the angiogram eliminates bone densities and improves vessel definition </li></ul><ul><ul><li>Phases: </li></ul></ul><ul><ul><ul><li>Arterial </li></ul></ul></ul><ul><ul><ul><li>Capillary </li></ul></ul></ul><ul><ul><ul><li>Venous </li></ul></ul></ul><ul><ul><ul><ul><li>Carotid </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vertebral </li></ul></ul></ul></ul>
  14. 18. Interventional angiography <ul><li>Embolization </li></ul><ul><ul><li>Particles (ivalon sponge) </li></ul></ul><ul><ul><li>Glue (isobutyl-2-cyanocrylate) </li></ul></ul><ul><ul><li>Balloon (detachable) for CC fistula </li></ul></ul><ul><ul><li>Platinum coils </li></ul></ul><ul><ul><li>Stents </li></ul></ul><ul><ul><li>Angioplasty </li></ul></ul>
  15. 19. Radionuclide imaging <ul><li>Single photon emission computed tomography (SPECT): </li></ul><ul><ul><li>Uses compounds labelled with gamma-emitting tracers (ligands) and a rotating gamma camera is often used for detection </li></ul></ul><ul><ul><li>Detection of early ischemia </li></ul></ul><ul><ul><li>Evaluation of patients with intractable epilepsy of temporal lobe origin </li></ul></ul><ul><ul><li>Thallium SPECT: differentiate low from high grade tumors. </li></ul></ul>
  16. 20. Radionuclide imaging <ul><li>Positron emission tomography (PET): </li></ul><ul><ul><li>Utilises positron-emitting isotopes bound to compounds of biological interest </li></ul></ul>
  17. 21. Lumbar puncture <ul><li>CSF analysis </li></ul><ul><li>CSF drainage and pressure reduction </li></ul><ul><li>Avoid LP: </li></ul><ul><ul><li>If raised intracranial pressure is suspected </li></ul></ul><ul><ul><li>If platelet count is less than 40 000 and prothrombin time is less than 50% of control </li></ul></ul>
  18. 22. Myelography
  19. 23. Others <ul><li>EEG </li></ul><ul><li>Evoked potentials: </li></ul><ul><ul><li>Visual </li></ul></ul><ul><ul><li>Auditory </li></ul></ul><ul><ul><li>Somatosensory </li></ul></ul><ul><li>EMG and NCS </li></ul><ul><li>Neuro-otological tests </li></ul><ul><ul><li>auditory system </li></ul></ul><ul><ul><li>vestibular system </li></ul></ul>

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