NEUROSURGERY Report

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Posts Tagged ‘computed tomography

Current Concepts in Sports Concussion: Imaging Concussion: A Review

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Screen Shot 2014-10-01 at 10.27.55 AMConcussion is a significant public health problem that is receiving increased attention from physicians, the media, and the public. Recent studies suggest that persistent symptoms after concussion/mild traumatic brain injury (mTBI) may arise from structural or metabolic alterations in the brain, despite normal conventional neuroimaging studies. New, advanced neuroimaging techniques show promise in refining diagnosis and outcome prediction in concussion/mTBI. Here, we review some of these techniques, including diffusion tensor imaging, task-based and resting-state functional magnetic resonance imaging, as well as positron emission tomography, 1H magnetic resonance spectroscopy, and perfusion imaging. Although further validation is needed through large prospective studies that correlate these techniques with patient outcome, it is likely that the definitions of pathoanatomic lesions, and a better understanding of their relationship to symptoms and prognosis, will continue to evolve as neuroimaging techniques continue to progress.

From: Imaging Concussion: A Review by Manley et al.

Current Concepts in Sports Concussion is online and full-text access is free.

Ahead of Print: Depth Electrode Localization Error

Brain_Imaging_in_Chronic_Epilepsy_Patients_afterBackground: The accurate localization of depth electrodes in epilepsy surgery is important for correct interpretation of stereoelectroencephalography recordings and neurosurgical resection. Unfortunately, image quality in post-implantation magnetic resonance imaging (MRI) is degraded by metal artifacts. The registration of post-implantation computed tomography (CT) or MRI to pre-implantation (artifact fee) MRI facilitates electrode imaging and optimal visualization of brain anatomy. However, registration errors negatively affect electrode localization accuracy.

Objective: To compare the relative registration deviation between post-implantation CT and MRI to pre-implantation MRI.

Methods: Retrospectively, 14 pharmacoresistant epilepsy patients were included who underwent stereotactic insertion of multiple depth electrodes and pre- and post-implantation MRI and as well as post-implantation CT. Post-implantation MRI and CT image sets were registered to pre-implantation MRI. The registration error between the registered post-implantation MRI and CT was quantified by measuring the geometrical distance between the electrodes of the registered post-implantation CT and post-implantation MRI.

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Ahead of Print: Subarachnoid Hemorrhage Grading Scale

Background: Although the Fisher scale is commonly used to grade vasospasm risk in aneurysmal subarachnoid hemorrhage (aSAH) patients, it fails to account for increasing SAH thickness.

Objective: We developed a simple quantitative scale based on maximal SAH thickness and compared its reproducibility and ability to predict symptomatic vasospasm against the Fisher scale.

Methods: The incidence of radiographic and symptomatic vasospasm among 250 aSAH patients treated at our institution was investigated. Admission head computed tomography (CT) scans were graded according to the Fisher scale and the proposed scale, which assigns a score from 1 to 5 based on a single measurement of maximum SAH thickness. We calculated vasospasm risk per grade for the Fisher scale and the proposed scale, and compared inter- and intraobserver variability for both scales.

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Written by NEUROSURGERY® Editorial Office

August 30, 2012 at 7:49 AM

Free CME Article: Initial Clinical Scales After Severe TBI

Background: Prediction of clinical course and outcome after severe traumatic brain injury (TBI) is important.

Objective: To examine whether clinical scales (Glasgow Coma Scale [GCS], Injury Severity Score [ISS], and Acute Physiology and Chronic Health Evaluation II [APACHE II]) or radiographic scales based on admission computed tomography (Marshall and Rotterdam) were associated with intensive care unit (ICU) physiology (intracranial pressure [ICP], brain tissue oxygen tension [PbtO2]), and clinical outcome after severe TBI.

Methods: One hundred one patients (median age, 41.0 years; interquartile range [26-55]) with severe TBI who had ICP and PbtO2 monitoring were identified. The relationship between admission GCS, ISS, APACHE II, Marshall and Rotterdam scores and ICP, PbtO2, and outcome was examined by using mixed-effects models and logistic regression.

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Ahead of Print: Diagnostic Accuracy of EMG and Imaging Studies

Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is sometimes difficult to diagnose, and a late diagnosis may result in permanent nerve damage. Electromyography (EMG), ultrasonography (US), magnetic resonance imaging (MRI), and computed tomography (CT) may be performed for the diagnosis. The diagnostic accuracy of these tests is well documented, but most of these studies accept EMG as the gold standard.

Objective: To evaluate the diagnostic accuracy of EMG, MRI, CT, and US for the diagnosis of carpal tunnel syndrome using clinical findings as the gold standard.

Methods: Patients suspected to have CTS on presentation to the outpatient clinic were evaluated. The tests were performed after a detailed physical examination. Both wrists of the 69 patients in the study were investigated.

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Written by NEUROSURGERY® Editorial Office

January 5, 2012 at 2:23 PM

Ahead of Print: Initial Scales Predicting ICU Parameters?

Background: Prediction of clinical course and outcome after severe traumatic brain injury (TBI) is important.

Objective: To examine whether clinical scales (Glasgow Coma Scale [GCS], Injury Severity Score [ISS] and APACHE II) or radiographic scales based on admission CT (Marshall and Rotterdam) were associated with ICU physiology (intracranial pressure [ICP], brain tissue oxygen tension [PbtO2]) and clinical outcome after severe TBI.

Methods: One hundred and one patients (median age 41.0 years IQR [26-55]) with severe TBI who had ICP and PbtO2 monitoring were identified. The relationship between admission GCS, ISS, APACHE II, Marshall and Rotterdam scores and ICP, PbtO2 and outcome was examined using mixed-effects models and logistic regression.

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Written by NEUROSURGERY® Editorial Office

December 5, 2011 at 7:40 AM

Ahead of Print: Incidence of Blunt Craniocervical Artery Injuries: Use of Whole Body CT Trauma Imaging with Adapted CT Angiography

Full article access for Neurosurgery subscribers.

BACKGROUND: The incidence of traumatic craniocervical artery dissection varies in published trauma series.

OBJECTIVE: To determine the frequency of traumatic craniocervical artery injury in polytrauma patients by using a standardized whole body trauma computed tomography (WBCT) with an adapted CT angiography (CTA) of the craniocervical vessels.

METHODS: 718 consecutive patients requiring a whole body trauma CT (16-row-multi-slice) due to the mechanism of their injury patterns and an Injury Severity Sale of greater than 16 were analyzed prospectively. After cranial scan, the CT angiography of the craniocervical vessels with 40 ml of iodinated contrast agent was performed using bolus tracking.

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Written by NEUROSURGERY® Editorial Office

April 21, 2011 at 9:00 AM

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