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Shafique MA, Mustafa MS, Luke-Wold B, Kumar A, Rangwala BS, Abdullah M, Ali SMS, Iqbal J, Haseeb A. Surgical strategies in acute subdural hematoma: a meta-analysis of decompressive craniectomy vs. craniotomy. Acta Neurochir (Wien) 2024; 166:121. [PMID: 38436794 DOI: 10.1007/s00701-024-06013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Acute subdural hematoma (ASDH) stands as a significant contributor to morbidity after severe traumatic brain injuries (TBI). The primary treatment approach for patients experiencing progressive neurological deficits or notable mass effects is the surgical removal of the hematoma, which can be achieved through craniotomy (CO) or decompressive craniectomy (DC). Nevertheless, the choice between these two procedures remains a subject of ongoing debate and controversy. MATERIALS AND METHODS We conducted a comprehensive literature review, utilizing prominent online databases and manually searching references related to craniotomy and craniectomy for subdural hematoma evacuation up to November 2023. Our analysis focused on outcome variables such as the presence of residual subdural hematoma, the need for revision procedures, and overall clinical outcomes. RESULTS We included a total of 11 comparative studies in our analysis, encompassing 4269 patients, with 2979 undergoing craniotomy and 1290 undergoing craniectomy, meeting the inclusion criteria. Patients who underwent craniectomy displayed significantly lower scores on the Glasgow Coma Scale (GCS) during their initial presentation. Following surgery, the DC group exhibited a significantly reduced rate of residual subdural (P = 0.009). Additionally, the likelihood of a poor outcome during follow-up was lower in the CO group. Likewise, the mortality rate was lower in the CO group compared to the craniectomy group (OR 0.63, 95% CI 0.41-0.98, I2 = 84%, P = 0.04). CONCLUSION Our study found that CO was associated with more favorable outcomes in terms of mortality, reoperation rate, and functional outcome while DC was associated with less likelihood of residual subdural hematoma. Upon further investigation of patient characteristics who underwent into either of these interventions, it was very clear that patients in DC cohort have more serious and low pre-op characteristics than the CO group. Nonetheless, brain herniation and advanced age act as independent factor for predicting the outcome irrespective of the intervention.
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Affiliation(s)
- Muhammad Ashir Shafique
- Department of Neurosurgery, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan.
| | - Muhammad Saqlain Mustafa
- Department of Neurosurgery, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Brandon Luke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Aashish Kumar
- Department of Neurosurgery, Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75010, Pakistan
| | - Burhanuddin Sohail Rangwala
- Department of Neurosurgery, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Muhammad Abdullah
- Department of Neurosurgery, Rai Medical College, Lahore Road, Sargodha City, 40100, Punjab, Pakistan
| | - Syed Muhammad Sinaan Ali
- Department of Neurosurgery, Liaquat National Hospital and Medical College, National Stadium Rd, Karachi, 74800, Pakistan
| | - Javed Iqbal
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
| | - Abdul Haseeb
- Department of Neurosurgery, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
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Rangankar V, Singh A, Khaladkar S. Pictorial review of the post-operative cranium. SA J Radiol 2023; 27:2684. [PMID: 38059119 PMCID: PMC10696547 DOI: 10.4102/sajr.v27i1.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 12/08/2023] Open
Abstract
Imaging evaluation of the brain and cranium after cranial surgery is a routine and significant part of the workflow of a radiology department. Various normal expected findings and early and late complications are associated with the post-operative cranium. In this pictorial review, the authors describe the typical imaging features of the spectrum of various conditions associated with cranial surgery with illustrative cases. Contribution A good knowledge and understanding of the spectrum of imaging appearances in the post-operative cranium is vital for the radiologist to accurately diagnose potential complications and distinguish them from normal post-operative findings, improving patient outcomes and guiding further treatment.
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Affiliation(s)
- Varsha Rangankar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Anmol Singh
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Sanjay Khaladkar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
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Sato Y, Takeuchi T, Fuju A, Takahashi M, Hashimoto M, Okawa R, Hayashi N. MRI safety for leave-on powdered hair thickeners under 1.5-T and 3.0-T MRI: measurement of deflection force, MRI artifact, and evaluation of preexamination screening. Phys Eng Sci Med 2023; 46:915-924. [PMID: 37155115 DOI: 10.1007/s13246-023-01267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
This study aimed to clarify the magnetic resonance imaging (MRI) compatibility of leave-on powdered hair thickeners by evaluating the displacement force and image artifacts of commercially available leave-on powdered hair thickeners on MRI devices and their response to metal and ferromagnetic detectors. Thirteen types of leave-on powdered hair thickeners were studied: nine hair thickener and four foundation types. MRI systems of 1.5 T and 3.0 T were used. Deflection angles and MR image artifacts according to ASTM F2052 and F2119 were evaluated. Handheld metal and ferromagnetic detectors were used to investigate whether hair thickeners could be detected in screening before MRI examinations. The hair thickener type had a deflection angle of 0°, whereas the foundation type had a deflection angle of 90°, indicating a strong physical effect. Significant image artifacts appeared only on the foundation type. The foundation type reacted at distances of less than 10 cm only with a ferromagnetic detector. Foundation-type leave-on powdered hair thickeners containing magnetic substances exhibited strong physical effects and produced significant image artifacts, and those can only be detected by screening with a ferromagnetic detector.
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Affiliation(s)
- Yusuke Sato
- Department of Radiology, Gunma University Hospital, Maebashi, Japan.
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan.
| | - Tomokazu Takeuchi
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Atsuya Fuju
- Department of Radiological Technology, Kiryu Kosei General Hospital, Kiryu, Japan
| | - Masahiko Takahashi
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
- Department of Central Radiology, Isesaki Municipal Hospital, Isesaki, Japan
| | - Maiko Hashimoto
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
- Department of Central Radiology, Isesaki Municipal Hospital, Isesaki, Japan
| | - Ryuya Okawa
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
- Department of Diagnostic Imaging, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Japan
| | - Norio Hayashi
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
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Takatsu Y, Yoshida R, Yamatani Y, Kanno M, Miyati T. Can magnetic resonance imaging after cranioplasty using titanium mesh detect brain tumors? Phys Eng Sci Med 2023; 46:109-118. [PMID: 36472801 DOI: 10.1007/s13246-022-01200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
This study determined the dependence of the concentration and position of contrast-enhanced tumors on the radio frequency (RF)-shielding effect of titanium mesh using the contrast-to-noise ratio (CNR) in magnetic resonance imaging (MRI). A phantom was constructed by filling a plastic container with manganese chloride tetrahydrate and agar. Four cellophane cylindrical containers were arranged from the end of the plastic container, and the brain tumor model was filled with gadobutrol diluted with NaCl, with molarity values of 0.2-1.0 mmol/L. The titanium mesh board was set on the left side of the phantom. Images were acquired using a 1.5-T MRI as well as two-dimensional spin-echo (2D SE) and three-dimensional fast spoiled gradient echo (3D FSPGR) sequences. CNR was calculated using the signal intensity values of the tumor model, surrounding area of the brain model, and background noise. Furthermore, the fractional change in CNR was calculated using values of CNR with and without the mesh. Moreover, a profile of CNR was created. The fractional change in CNR decreased at the brain tumor positions present near the mesh and at a contrast medium concentration of approximately ≤ 0.5 mmol/L in 2D SE and ≤ 0.25 mmol/L in 3D FSPGR. According to the CNR profiles, directly under the mesh, almost all contrast concentrations in 2D SE was unrecognizable; however, at a concentration of ≥ 0.5 mmol/L in 3D FSPGR was recognizable.
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Affiliation(s)
- Yasuo Takatsu
- Molecular Imaging, School of Medical Sciences, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Rei Yoshida
- Department of Radiology, Kurihara Central Hospital, 3-3-1 Miyano chuo, Tsukidate, Kurihara-city, Miyagi, 987-2205, Japan
| | - Yuya Yamatani
- Division of Central Radiology, Nara Medical University Hospital, 840, Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mikihisa Kanno
- Department of Radiological Technology, Minami Matsuyama Hospital, 3-10, Asodamachi, Matsuyama, Ehime, 790-8534, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
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Effat KG. Chronic craniomandibular pain after craniotomy: A long-term clinical study. Cranio 2022:1-8. [PMID: 36503374 DOI: 10.1080/08869634.2022.2154930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Chronic craniomandibular/cervical pain and temporomandibular disorders have not been studied in patients who had a craniotomy several years previously. The aim of the current clinical work was to address these issues. METHODS A total group of 150 ambulant patients who had a previous craniotomy was subclassified according to whether or not the temporalis muscle was manipulated. RESULTS The average incidence of multiple subsite regional head and neck pain was 69.3% a number of years after a craniotomy. Evidence of internal derangement of the temporomandibular joint was significantly higher in the group that required manipulation of the temporalis muscle during the procedure. CONCLUSION The pattern of chronic craniomandibular/cervical pain experienced years after a craniotomy supports the brain neuromatrix theory of pain.
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Affiliation(s)
- Kamal G Effat
- Department of Otolaryngology, El- Sahel Teaching Hospital, Cairo, Egypt
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Guo X, Wu L, Ou Y, Yu X, Zhu B, Yang C, Liu W. Postoperative pneumocephalus and recurrence and outcome of chronic subdural hematoma: a systematic review and meta-analysis. Neurosurg Rev 2022; 46:13. [PMID: 36481957 DOI: 10.1007/s10143-022-01925-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/12/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
We conducted a meta-analysis to analyze the effects of pneumocephalus after chronic subdural hematoma (CSDH) surgery on hematoma recurrence, mortality, and functional outcomes. In this meta-analysis, following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science online databases were queried using the keywords "pneumocephalus," "pneumoencephalos," "intracranial pneumatocele," "pneumo encephalon," "subdural air," and "chronic subdural hematoma." The results were limited to English-language articles. Through the online database, we identified a total of 276 articles and finally included 14 articles for meta-analysis. The results showed that the recurrence rate in the pneumocephalus group was higher than that in the control group, with a pooled OR of 3.35 (CI: 2.51-4.46, P < 0.001). There was no difference in recurrence rate between the no/few and moderate pneumocephalus groups (OR: 1.27, CI: 0.68-2.37, P = 0.46), but the recurrence rate of the large pneumocephalus group was significantly higher than that of the moderate group, with a pooled OR of 3.29 (CI: 1.71-6.32, P < 0.001). This study failed to show higher mortality and worse outcomes in the pneumocephalus group than in the control. Pneumocephalus after surgical evacuation of CSDH was associated with the recurrence rate of hematoma. Pneumocephalus affecting recurrence was correlated with gas volume, and moderate pneumocephalus may have less impact, while patients with large pneumocephalus are more likely to recur than those with moderate pneumocephalus. More prospective cohort studies are needed for further investigation and verification. This meta-analysis was registered (PROSPERO CRD42022321800).
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Affiliation(s)
- Xufei Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Xiaofan Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bingcheng Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cheng Yang
- The Third Clinical Medical College, Ningxia Medical University, Yinchuan, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Neurological Center, People's Hospital of Ningxia Hui Autonomous Region (The Third Clinical Medical College, Ningxia Medical University), Yinchuan, China.
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Akdogan G, Istanbullu OB. Analysing the effects of metallic biomaterial design and imaging sequences on MRI interpretation challenges due to image artefacts. Phys Eng Sci Med 2022; 45:1163-1174. [PMID: 36306073 DOI: 10.1007/s13246-022-01183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 10/01/2022] [Indexed: 12/15/2022]
Abstract
Biometals cause signal loss and susceptibility artefacts in the surrounding tissue, resulting in deterioration in magnetic resonance (MR) images. This metal-artefact effect may lead to interpretation challenges for MR images. Therefore, artefact reduction is required to obtain higher-quality images. This paper aims to analyse the impact of imaging sequence and metallic biomaterial design on MR image artefacts. In this respect, implant specimens were designed in thin, thick, and pointed forms and manufactured using 316LVM, 316L, CoCr-alloy, and Ti-alloy, which are commonly utilized materials in the biomaterials field. Specimens were placed in a phantom that simulates average human anatomy separately and scanned in a 1.5 T MRI under four imaging conditions: "Axial-T1-Gradient-Echo (GRE)", "Sagittal-T1-GRE", "Axial-T2-Spin-Echo (SE)" and "Sagittal-T2-SE". Images were analysed regarding image artefact amount. The lower magnetic susceptibility of Ti-alloy specimens caused 84.76% less deterioration than 316LVM specimens in the MR images with the mean image artefact-to-specimen size ratio. Thinner implant designs provided better performance regarding the metal artefact by reducing the artefact-to-specimen size ratio. T2SE decreased the image artefact by 44.7% for 316LVM and 54.6% for Ti-Alloy specimens and provided better image quality than T1GRE for clinical interpretation. This study reveals that image artefacts directly depend on material content, implant volume, geometry, and imaging sequence selection. The minor artefact effect of T2SE provides more accurate MR images than T1GRE regarding the interpretation of the images of the patients with biometals. The higher magnetic susceptibility of biometals causes more deterioration of the images.
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Affiliation(s)
- Gulsen Akdogan
- Department of Biomedical Engineering, Faculty of Engineering, Erciyes University, Kayseri, Turkey.
| | - Omer Burak Istanbullu
- Department of Biomedical Engineering, Faculty of Engineering, Erciyes University, Kayseri, Turkey
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Boshra R, Eradath M, Dougherty K, Wu B, Morea BM, Harris M, Pinsk MA, Kastner S. Case studies in neuroscience: reversible signatures of edema following electric and piezoelectric craniotomy drilling in macaques. J Neurophysiol 2022; 128:919-926. [PMID: 36043799 PMCID: PMC9550573 DOI: 10.1152/jn.00108.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/28/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
In vivo electrophysiology requires direct access to brain tissue, necessitating the development and refinement of surgical procedures and techniques that promote the health and well-being of animal subjects. Here, we report a series of findings noted on structural magnetic resonance imaging (MRI) scans in monkeys with MRI-compatible implants following small craniotomies that provide access for intracranial electrophysiology. We found distinct brain regions exhibiting hyperintensities in T2-weighted scans that were prominent underneath the sites at which craniotomies had been performed. We interpreted these hyperintensities as edema of the neural tissue and found that they were predominantly present following electric and piezoelectric drilling, but not when manual, hand-operated drills were used. Furthermore, the anomalies subsided within 2-3 wk following surgery. Our report highlights the utility of MRI-compatible implants that promote clinical examination of the animal's brain, sometimes revealing findings that may go unnoticed when incompatible implants are used. We show replicable differences in outcome when using electric versus mechanical devices, both ubiquitous in the field. If electric drills are used, our report cautions against electrophysiological recordings from tissue directly underneath the craniotomy for the first 2-3 wk following the procedure due to putative edema.NEW & NOTEWORTHY Close examination of structural MRI in eight nonhuman primates following craniotomy surgeries for intracranial electrophysiology highlights a prevalence of hyperintensities on T2-weighted scans following surgeries conducted using electric and piezoelectric drills, but not when using mechanical, hand-operated drills. We interpret these anomalies as edema of neural tissue that resolved 2-3 wk postsurgery. This finding is especially of interest as electrophysiological recordings from compromised tissue may directly influence the integrity of collected data immediately following surgery.
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Affiliation(s)
- Rober Boshra
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Manoj Eradath
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Kacie Dougherty
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Bichan Wu
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Britney M Morea
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Michael Harris
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Mark A Pinsk
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Sabine Kastner
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
- Department of Psychology, Princeton University, Princeton, New Jersey
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Posttraumatic Headaches and Postcraniotomy Syndromes. Neurol Clin 2022; 40:609-629. [PMID: 35871787 DOI: 10.1016/j.ncl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Headaches following head trauma or craniotomy have multiple causes, each of which has characteristic imaging features. Posttraumatic headaches may relate to intracranial hemorrhage, fracture, shear injury, mass effect, or vascular injury. Various complications of craniotomy and craniectomy may manifest with headache. CT and MRI of the brain play important roles in diagnosing these causes of headache.
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Doron O, D’Amico RS, Langer DJ. The Cranial Window: Opportunities for the Use of Bedside Ultrasound Facilitated by Sonolucent Implants in Neurosurgical Patients. World Neurosurg 2022; 165:142-144. [DOI: 10.1016/j.wneu.2022.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Takatsu Y, Yamamura K, Yamatani Y, Takahashi D, Yoshida R, Asahara M, Honda M, Miyati T. Echo-planar imaging is superior to fast spin-echo diffusion-weighted imaging for cranioplasty using titanium mesh in brain magnetic resonance imaging: a phantom study. Radiol Phys Technol 2021; 15:89-99. [PMID: 34855114 DOI: 10.1007/s12194-021-00646-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022]
Abstract
This study aimed to compare the radiofrequency (RF) shielding effects of titanium mesh of echo-planar imaging (EPI) versus fast spin-echo (FSE) diffusion-weighted imaging (DWI) to establish a suitable sequence for patients who undergo cranioplasty and for whom titanium mesh was used in brain magnetic resonance imaging (MRI). A 1.5-T MRI scanner with clinical setting sequences was used. A phantom for the examination constructed using a sucrose solution in a plastic container was used to compare the signal attenuation (SA) ratio, area of RF shielding effect (Area), normalized absolute average deviation (NAAD), and apparent diffusion coefficient (ADC) between EPI and FSE-DWI. EPI provided significantly better SA ratio, Area, and NAAD (P < 0.01). When the number of slices increased, the RF shielding became more negative. There was no significant difference in the ADC. Regardless of the k-trajectory, EPI-DWI had a lower RF shielding effect than FSE-DWI in patients undergoing cranioplasty.
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Affiliation(s)
- Yasuo Takatsu
- Department of System Control Engineering, Graduate School of Engineering, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan. .,Department of Radiological Technology, Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan. .,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Kenichiro Yamamura
- Department of Radiological Technology, Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan
| | - Yuya Yamatani
- Division of Central Radiology, Nara Medical University Hospital, 840, Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Takahashi
- Department of Radiological Technology, Iwate Prefectural Central Hospital, 4-1, 1 Cho-me, Ueda, Morioka City, Iwate, 020-0066, Japan
| | - Rei Yoshida
- Department of Radiology, Kurihara Central Hospital, 3-3-1 Miyano cyuou, Tsukidate, Kurihara-City, Miyagi, 987-2205, Japan
| | - Masaki Asahara
- Department of Radiological Technology, Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan
| | - Michitaka Honda
- Department of Radiological Technology, Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
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Pain Quality Among Hospitalized Postcraniotomy Brain Tumor Patients. CLIN NURSE SPEC 2021; 35:129-137. [PMID: 33793175 DOI: 10.1097/nur.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/AIMS The aim of this study was to describe how persons given a diagnosis of a brain tumor who have had a craniotomy describe the quality of their pain after surgery. DESIGN A qualitative descriptive design was used. METHODS Qualitative descriptive methods as described by Sandelowski guided this study. Semistructured interviews were conducted with patients hospitalized on a neurological step-down unit in an urban teaching hospital in the Midwestern United States. Interviews focused on the quality of participants' pain after surgery. Narratives were analyzed using standard content analysis. RESULTS Twenty-seven participants were interviewed. Most were White and female. Most underwent a craniotomy using an anterior approach with sedation. Participants described the quality of their pain with 6 different types of descriptors: pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. CONCLUSIONS Participants' descriptions of their pain quality after surgery provide a different understanding than do numerical pain ratings. Clinicians should use questions to explore patients' individual pain experiences, seeking to understand the quality of patients' pain and their perceptions.
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Khodarahmi I, Alizai H, Chalian M, Alaia EF, Burke CJ, Slasky SE, Wenokor C. Imaging Spectrum of Calvarial Abnormalities. Radiographics 2021; 41:1144-1163. [PMID: 34197249 DOI: 10.1148/rg.2021200198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Calvarial abnormalities are usually discovered incidentally on radiologic studies or less commonly manifest with symptoms. This narrative review describes the imaging spectrum of the abnormal calvaria. The extent, multiplicity, and other imaging features of calvarial abnormalities can be combined with the clinical information to establish a final diagnosis or at least narrow the differential considerations. Prior trauma (congenital depression, leptomeningeal cysts, posttraumatic osteolysis), surgical intervention (flap osteonecrosis and burr holes), infection, and inflammatory processes (sarcoidosis) can result in focal bone loss, which may also be seen with idiopathic disorders without (bilateral parietal thinning and Gorham disease) or with (Parry-Romberg syndrome) atrophy of the overlying soft tissues. Anatomic variants (arachnoid granulations, venous lakes, parietal foramina) and certain congenital lesions (epidermoid and dermoid cysts, atretic encephalocele, sinus pericranii, and aplasia cutis congenita) manifest as solitary lytic lesions. Other congenital entities (lacunar skull and dysplasia) display a diffuse pattern of skull involvement. Several benign and malignant primary bone tumors involve the calvaria and manifest as lytic, sclerotic, mixed lytic and sclerotic, or thinning lesions, whereas multifocal disease is mainly due to hematologic or secondary malignancies. Metabolic disorders such as rickets, hyperparathyroidism, renal osteodystrophy, acromegaly, and Paget disease involve the calvaria in a more diffuse pattern. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Iman Khodarahmi
- From the Division of Musculoskeletal Imaging, Department of Radiology, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, Room 223, New York, NY 10016 (I.K., E.F.A., C.J.B.); Department of Radiology, Scottish Rite Hospital for Children, Dallas, Tex (H.A.); Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Wash (M.C.); Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.E.S.); and Division of Musculoskeletal Radiology, Department of Radiology, Rutgers University Hospital, Newark, NJ (C.W.)
| | - Hamza Alizai
- From the Division of Musculoskeletal Imaging, Department of Radiology, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, Room 223, New York, NY 10016 (I.K., E.F.A., C.J.B.); Department of Radiology, Scottish Rite Hospital for Children, Dallas, Tex (H.A.); Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Wash (M.C.); Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.E.S.); and Division of Musculoskeletal Radiology, Department of Radiology, Rutgers University Hospital, Newark, NJ (C.W.)
| | - Majid Chalian
- From the Division of Musculoskeletal Imaging, Department of Radiology, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, Room 223, New York, NY 10016 (I.K., E.F.A., C.J.B.); Department of Radiology, Scottish Rite Hospital for Children, Dallas, Tex (H.A.); Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Wash (M.C.); Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.E.S.); and Division of Musculoskeletal Radiology, Department of Radiology, Rutgers University Hospital, Newark, NJ (C.W.)
| | - Erin F Alaia
- From the Division of Musculoskeletal Imaging, Department of Radiology, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, Room 223, New York, NY 10016 (I.K., E.F.A., C.J.B.); Department of Radiology, Scottish Rite Hospital for Children, Dallas, Tex (H.A.); Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Wash (M.C.); Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.E.S.); and Division of Musculoskeletal Radiology, Department of Radiology, Rutgers University Hospital, Newark, NJ (C.W.)
| | - Christopher J Burke
- From the Division of Musculoskeletal Imaging, Department of Radiology, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, Room 223, New York, NY 10016 (I.K., E.F.A., C.J.B.); Department of Radiology, Scottish Rite Hospital for Children, Dallas, Tex (H.A.); Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Wash (M.C.); Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.E.S.); and Division of Musculoskeletal Radiology, Department of Radiology, Rutgers University Hospital, Newark, NJ (C.W.)
| | - Shira E Slasky
- From the Division of Musculoskeletal Imaging, Department of Radiology, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, Room 223, New York, NY 10016 (I.K., E.F.A., C.J.B.); Department of Radiology, Scottish Rite Hospital for Children, Dallas, Tex (H.A.); Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Wash (M.C.); Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.E.S.); and Division of Musculoskeletal Radiology, Department of Radiology, Rutgers University Hospital, Newark, NJ (C.W.)
| | - Cornelia Wenokor
- From the Division of Musculoskeletal Imaging, Department of Radiology, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, Room 223, New York, NY 10016 (I.K., E.F.A., C.J.B.); Department of Radiology, Scottish Rite Hospital for Children, Dallas, Tex (H.A.); Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Wash (M.C.); Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.E.S.); and Division of Musculoskeletal Radiology, Department of Radiology, Rutgers University Hospital, Newark, NJ (C.W.)
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Shinohara Y, Ohmura T, Sasaki F, Inomata T, Itoh T, Kinoshita T. Appropriate iMAR presets for metal artifact reduction from surgical clips and titanium burr hole covers on postoperative non-contrast brain CT. Eur J Radiol 2021; 141:109811. [PMID: 34102563 DOI: 10.1016/j.ejrad.2021.109811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate suitable iterative metal artifact reduction (iMAR) presets for titanium neurosurgical clips and burr hole covers (BHCs) on postoperative non-contrast computed tomography (NCCT). METHOD Twenty-two patients who underwent NCCT after intracranial aneurysmal clipping were included. NCCT images were postprocessed using eight currently available iMAR presets. In each image, a circular region of interest (ROI) was placed around clip, BHC, and on parietal lobe as reference. Standard deviation (SD) and attenuation value (HU) were measured in each ROI to obtain artifact index (AI) and contrast-to-noise ratio (CNR). For each iMAR preset, SD, AI, HU, and CNR were compared with those without iMAR for clips and BHCs. Visual assessment around each clip and BHC was performed by two neuroradiologists using three-point visual score (VS) (1 = no apparent, 2 = minor, and 3 = severe artifacts). RESULTS Among the presets, the neuro-coils preset (iMAR-NC) showed the lowest SD, AI, and VS for clips (P < 0.001). For BHCs, HU, CNR, and VS with iMAR-NC were significantly higher than those without iMAR (P < 0.001). SD, AI, and VS with the shoulder implants preset (iMAR-ShI) were significantly lower than those without iMAR for clips (P = 0.002, 0.002, and P < 0.001, respectively). For BHCs, VS with iMAR-ShI was lowest among the presets (P = 0.004). CONCLUSIONS Although iMAR-NC reduces metal artifacts from clips, it strengthens artifacts from BHCs. For postoperative NCCT, iMAR-ShI most effectively reduces metal artifacts from both clips and BHCs in a single preset.
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Affiliation(s)
- Yuki Shinohara
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan.
| | - Tomomi Ohmura
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan.
| | - Fumiaki Sasaki
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan.
| | - Takato Inomata
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan.
| | - Toshihide Itoh
- CT Research and Collaboration Department, Diagnostic Imaging Division, Siemens Healthcare K.K., Gate City Osaki West Tower 1-11-1 Osaki, Shinagawa-ku, Tokyo, 141-8644, Japan.
| | - Toshibumi Kinoshita
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan.
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15
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Motoyama Y, Kogeichi Y, Matsuoka R, Takamura Y, Takeshima Y, Matsuda R, Tamura K, Nishimura F, Yamada S, Nakagawa I, Saito K, Park YS, Sugie K, Fukushima H, Nakase H. External Brain Tamponade Paradoxically Induced by Cerebrospinal Fluid Hypovolemia After Decompressive Craniectomy: A Retrospective Cohort Study. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okaa023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Hoz SS, Al-Sharshahi ZF, Alrawi MA, Al-Dhahir MA. Traumatic acute extracranial cerebral herniation: How much do we know? Surg Neurol Int 2021; 12:63. [PMID: 33654566 PMCID: PMC7911033 DOI: 10.25259/sni_492_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/22/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Mohammed A Alrawi
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Mohammed A Al-Dhahir
- Department of Neurosurgery, Strong Memorial Hospital University of Rochester, Rochester, New York, United States
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17
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Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure. Sci Rep 2020; 10:13626. [PMID: 32788610 PMCID: PMC7423943 DOI: 10.1038/s41598-020-70614-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/09/2020] [Indexed: 11/08/2022] Open
Abstract
This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup that simulates the intracranial hydrodynamics of a pneumocephalus patient during flight. It consists of an acrylic box (skull), air-filled balloon [intracranial air (ICA)], water-filled balloon (cerebrospinal fluid and blood) and agarose gel (brain). The cabin was replicated using a custom-made pressure chamber. The setup can measure the rise in ICP during depressurization to levels similar to that inside the cabin at cruising altitude. ΔICP, i.e. the difference between mean cruising ICP and initial ICP, was found to increase with ICA volume and ROC. However, ΔICP was independent of the initial ICP. The largest ΔICP was 5 mmHg; obtained when ICA volume and ROC were 20 ml and 1,600 ft/min, respectively. The postulated ICA expansion and the subsequent increase in ICP in pneumocephalus patients during flight were successfully quantified in a laboratory setting. Based on the quantitative and qualitative analyses of the results, an ICA volume of 20 ml and initial ICP of 15 mmHg were recommended as conservative thresholds that are required for safe air travel among pneumocephalus patients. This study provides laboratory data that may be used by doctors to advise post-neurosurgical patients if they can safely fly.
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18
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Riveros Gilardi B, Muñoz López JI, Hernández Villegas AC, Garay Mora JA, Rico Rodríguez OC, Chávez Appendini R, De la Mora Malváez M, Higuera Calleja JA. Types of Cerebral Herniation and Their Imaging Features. Radiographics 2020; 39:1598-1610. [PMID: 31589570 DOI: 10.1148/rg.2019190018] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cerebral herniation, defined as a shift of cerebral tissue from its normal location into an adjacent space, is a life-threatening condition that requires prompt diagnosis. The imaging spectrum can range from subtle changes to clear displacement of brain structures. For radiologists, it is fundamental to be familiar with the different imaging findings of the various subtypes of brain herniation. Brain herniation syndromes are commonly classified on the basis of their location as intracranial and extracranial hernias. Intracranial hernias can be further divided into three types: (a) subfalcine hernia; (b) transtentorial hernia, which can be ascending or descending (lateral and central); and (c) tonsillar hernia. Brain herniation may produce brain damage, compress cranial nerves and vessels causing hemorrhage or ischemia, or obstruct the normal circulation of cerebrospinal fluid, producing hydrocephalus. Owing to its location, each type of hernia may be associated with a specific neurologic syndrome. Knowledge of the clinical manifestations ensures a focused imaging analysis. To make an accurate diagnosis, the authors suggest a six-key-point approach: comprehensive analysis of a detailed history of the patient and results of clinical examination, knowledge of anatomic landmarks, direction of mass effect, recognition of displaced structures, presence of indirect radiologic findings, and possible complications. CT and MRI are the imaging modalities of choice used for establishing a correct diagnosis and guiding therapeutic decisions. They also have important prognostic implications. The preferred imaging modality is CT: the acquisition time is shorter and it is less expensive and more widely available. Patients with brain herniation are generally in critical clinical condition. Making a prompt diagnosis is fundamental for the patient's safety.©RSNA, 2019.
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Affiliation(s)
- Berta Riveros Gilardi
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
| | - José Ignacio Muñoz López
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
| | - Antonio Carlos Hernández Villegas
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
| | - Juan Alberto Garay Mora
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
| | - Oralia Cristina Rico Rodríguez
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
| | - Roberto Chávez Appendini
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
| | - Marianne De la Mora Malváez
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
| | - Jesús Antonio Higuera Calleja
- From the Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City, Mexico 14080 (B.R.G., A.C.H.V., J.A.G.M., O.C.R.R., R.C.A., M.D.L.M.M., J.A.H.C.); and Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (J.I.M.L.)
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19
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Carter LN, Addison O, Naji N, Seres P, Wilman AH, Shepherd DE, Grover L, Cox S. Reducing MRI susceptibility artefacts in implants using additively manufactured porous Ti-6Al-4V structures. Acta Biomater 2020; 107:338-348. [PMID: 32119921 DOI: 10.1016/j.actbio.2020.02.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 01/28/2023]
Abstract
Magnetic Resonance Imaging (MRI) is critical in diagnosing post-operative complications following implant surgery and imaging anatomy adjacent to implants. Increasing field strengths and use of gradient-echo sequences have highlighted difficulties from susceptibility artefacts in scan data. Artefacts manifest around metal implants, including those made from titanium alloys, making detection of complications (e.g. bleeding, infection) difficult and hindering imaging of surrounding structures such as the brain or inner ear. Existing research focusses on post-processing and unorthodox scan sequences to better capture data around these devices. This study proposes a complementary up-stream design approach using lightweight structures produced via additive manufacturing (AM). Strategic implant mass reduction presents a potential tool in managing artefacts. Uniform specimens of Ti-6Al-4V structures, including lattices, were produced using the AM process, selective laser melting, with various unit cell designs and relative densities (3.1%-96.7%). Samples, submerged in water, were imaged in a 3T MRI system using clinically relevant sequences. Artefacts were quantified by image analysis revealing a strong linear relationship (RR2 = 0.99) between severity and relative sample density. Likewise, distortion due to slice selection errors showed a squared relationship (RR2 = 0.92) with sample density. Unique artefact features were identified surrounding honeycomb samples suggesting a complex relationship exists for larger unit cells. To demonstrate clinical utility, a honeycomb design was applied to a representative cranioplasty. Analysis revealed 10% artefact reduction compared to traditional solid material illustrating the feasibility of this approach. This study provides a basis to strategically design implants to reduce MRI artefacts and improve post-operative diagnosis capability. STATEMENT OF SIGNIFICANCE: MRI susceptibility artefacts surrounding metal implants present a clinical challenge for the diagnosis of post-operative complications relating to the implant itself or underlying anatomy. In this study for the first time we demonstrate that additive manufacturing may be exploited to create lattice structures that predictably reduce MRI image artefact severity surrounding titanium alloy implants. Specifically, a direct correlation of artefact severity, both total signal loss and distortion, with the relative material density of these functionalised materials has been demonstrated within clinically relevant MRI sequences. This approach opens the door for strategic implant design, utilising this structurally functionalised material, that may improve post-operative patient outcomes and compliments existing efforts in this area which focus on data acquisition and post-processing methods.
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20
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Hofmann VM, Pudszuhn A, Niehues SM. Effective but uncommon treatment of a spontaneous otogenic epidural pneumocephalus. BMJ Case Rep 2019; 12:12/4/e228245. [PMID: 30975775 DOI: 10.1136/bcr-2018-228245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe an uncommon treatment for epidural pneumocephalus and an effective but uncommon treatment option. Complete and permanent relief was achieved in a young patient using a tympanostomy tube to eliminate excessive positive air pressure in the mastoid bone that was the cause of spontaneous pneumocephalus. The patient showed no recurrence and absence of clinical symptoms at outpatient follow-up. Post-traumatic, infectious or spontaneous pneumocephalus may require an active, usually surgical approach. Treatment with a tympanostomy tube can be an alternative in suitable patients.
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Affiliation(s)
- Veit-Maria Hofmann
- Klinik für Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annett Pudszuhn
- Klinik für Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Germany
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21
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Aldrich A, Kuss MA, Duan B, Kielian T. 3D Bioprinted Scaffolds Containing Viable Macrophages and Antibiotics Promote Clearance of Staphylococcus aureus Craniotomy-Associated Biofilm Infection. ACS APPLIED MATERIALS & INTERFACES 2019; 11:12298-12307. [PMID: 30855125 PMCID: PMC7034353 DOI: 10.1021/acsami.9b00264] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Craniotomy involves the removal of a skull fragment to access the brain, such as during tumor or epilepsy surgery, which is immediately replaced intraoperatively. The infection incidence after craniotomy ranges from 0.8 to 3%, with approximately half caused by Staphylococcus aureus ( S. aureus). To mitigate infectious complications following craniotomy, we engineered a three-dimensional (3D) bioprinted bone scaffold to harness the potent antibacterial activity of macrophages (MΦs) together with antibiotics using a mouse S. aureus craniotomy-associated biofilm model that establishes a persistent infection on the bone flap, subcutaneous galea, and brain. The 3D scaffold contained rifampin and daptomycin printed in a composite slurry, with viable MΦs incorporated into a hydrogel-based bioink, which was assessed for both the treatment and prevention of craniotomy-associated infections in the mouse model. For the treatment paradigm, the bone flap was removed at day 7 post infection after a mature biofilm had formed and was replaced with a 3D printed antibiotic scaffold, with or without MΦ incorporation. Bacterial burdens in the galea and brain were reduced by at least 100-fold at early time points, which was potentiated by bioprinting viable MΦs into the 3D antibiotic scaffold. We also examined a prevention paradigm, where the scaffolds were placed at the time of surgery and challenged with S. aureus one day later at the surgical site. Interestingly, unlike the treatment paradigm, the incorporation of viable MΦs into the 3D antibiotic scaffold did not enhance bacterial clearance compared to that of antibiotic alone. With further refinement, our 3D bioprinted scaffold represents a potential treatment modality, as it delivers therapeutic antibiotic levels more rapidly than systemic administration, based on its proximity to the infection site. In addition, the incorporation of viable MΦs into the 3D scaffold is an important advance, which demonstrated an improved therapeutic benefit for the treatment of established biofilms that represent the most clinically challenging scenario.
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Affiliation(s)
- Amy Aldrich
- Department of Pathology and Microbiology University of Nebraska Medical Center, Omaha, NE 68198
| | - Mitchell A. Kuss
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198
| | - Tammy Kielian
- Department of Pathology and Microbiology University of Nebraska Medical Center, Omaha, NE 68198
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22
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Krivoshapkin AL, Sergeev GS, Gaytan AS, Kalneus LE, Kurbatov VP, Abdullaev OA, Salim N, Bulanov DV, Simonovich AE. Automated Volumetric Analysis of Postoperative Magnetic Resonance Imaging Predicts Survival in Patients with Glioblastoma. World Neurosurg 2019; 126:e1510-e1517. [PMID: 30910753 DOI: 10.1016/j.wneu.2019.03.142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glioblastomas (GBMs) are primary brain tumors that are very difficult to treat. Magnetic resonance imaging (MRI) is the reference tool for diagnosis, postoperative control, and follow-up of GBM. The MRI tumor contrast enhancement part serves as a target for surgery. However, there are controversial data about the influence of pre- and postoperative tumor volumetric MRI parameters on overall survival (OS). METHODS Data of 57 patients with GBM were analyzed retrospectively. All patients had maximum safe resection and standard adjuvant treatment. All patients underwent 1.5-T MRI with contrast in the first 24 hours postoperatively. The data of pre- and postoperative volumetric parameters were analyzed using the original software. RESULTS Correlation analysis between the postoperative volume of the tumor contrast enhancement part and the patient's OS revealed a significant level (on the Chaddock scale) of inverse correlation. Residual tumor volume associated with OS of >6 months was determined as <2.5 cm3. The mortality risk in the first 6 months after tumor resection is 3.4 times higher when the tumor remnant is >2.5 cm3 (risk ratio, 3.4; P = 0.0002). CONCLUSIONS The volume of MRI contrast-enhancing GBM remnants after surgery, automatically measured by the software, was a significant predictor for early postoperative progression and death.
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Affiliation(s)
- Alexey L Krivoshapkin
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia.
| | - Gleb S Sergeev
- Neurosurgical Department, European Medical Center, Moscow, Russia
| | - Alekey S Gaytan
- Neurosurgical Department, European Medical Center, Moscow, Russia
| | - Leonid E Kalneus
- Physics Department, Novosibirsk State University, Novosibirsk, Russia
| | | | - Orkhan A Abdullaev
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
| | - Nidal Salim
- Radiotherapy Center, European Medical Center, Moscow, Russia
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Bani Sadr A, Gregoire B, Tordo J, Guyotat J, Boibieux A, Janier M. Potential utility of bone scan in cranial bone flap osteomyelitis. Ann Nucl Med 2019; 33:424-433. [PMID: 30887230 DOI: 10.1007/s12149-019-01351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/12/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Currently, the diagnosis of bone flap osteomyelitis (BFO) remains a challenge for medical imaging. The present study aimed to identify predictive scintigraphic patterns of BFO. METHODS This retrospective study reviewed planar bone scan of patients with suspected BFO between 2010, and 2016. A total of 15 patients were included. Final diagnosis of BFO was obtained by histological and bacteriological documentation. Eight scintigraphic signs potentially helpful were reviewed and correlated with the final diagnosis individually or in combination through Fischer exact test. RESULTS Eight patients out of 15 (53.3%) were diagnosed with BFO. Radionuclide uptake inside the bone flap during blood-pool phase was predictive for BFO (p = 0.007) with 75.0% sensitivity 100% specificity, and 86.7% accuracy. In combination, radionuclide uptake inside the bone flap or a spreading wavefront between blood-pool and delayed phases was associated with BFO (p = 0.007). It did not improve diagnostic performance. CONCLUSION Using well-defined and reproducible scintigraphic signs, bone scan is helpful for the diagnosis of BFO.
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Affiliation(s)
- Alexandre Bani Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bvd Pinel, 69634, Lyon Cedex, France. .,Department of Nuclear Medicine, East Group Hospital, Hospices Civils de Lyon, 59 Bvd Pinel, 69634, Lyon Cedex, France. .,Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 28 avenue Doyen Lépine, 69500, Bron, France.
| | - Bastien Gregoire
- Imagerie nucléaire de l'Ouest Lyonnais et de l'Ain, 25 Av des Sources, 69009, Lyon, France
| | - Jeremie Tordo
- Department of Nuclear Medicine, East Group Hospital, Hospices Civils de Lyon, 59 Bvd Pinel, 69634, Lyon Cedex, France
| | - Jacques Guyotat
- Department of Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bvd Pinel, 69634, Lyon Cedex, France.,Université Claude Bernard Lyon 1, 43 Bvd du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Andre Boibieux
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Marc Janier
- Department of Nuclear Medicine, East Group Hospital, Hospices Civils de Lyon, 59 Bvd Pinel, 69634, Lyon Cedex, France.,Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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Haber MA, Abd-El-Barr M, Gormley W, Mukundan S, Sodickson AD, Potter CA. Neurosurgical complications: what the radiologist needs to know. Emerg Radiol 2019; 26:331-340. [PMID: 30761443 DOI: 10.1007/s10140-019-01672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
Visits to the emergency department by patients who have recently undergone neurosurgery are a common occurrence, and these patients frequently receive emergent cross-sectional head imaging in order to evaluate for complications. Different neurosurgical approaches may have typical postoperative imaging findings that can be confused with pathology. Furthermore, particular abnormal postoperative imaging findings may signal an evolving complication. It is essential for the radiologist to understand common neurosurgical procedures and their potential complications in order to provide proper diagnostic evaluation of the postoperative neurosurgical patient. The purpose of this review is to assist radiologists in the evaluation of the postoperative neurosurgical patient and educate them on associated complications. Familiarity with common neurosurgical techniques and postoperative complications will help radiologists make the correct diagnosis, communicate effectively with the neurosurgeon, and expedite patient care.
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Affiliation(s)
- Matthew A Haber
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Muhammad Abd-El-Barr
- Department of Neurosurgery, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - William Gormley
- Harvard Medical School, Boston, MA, USA.,Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Srinivasan Mukundan
- Harvard Medical School, Boston, MA, USA.,Division of Neuroradiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Aaron D Sodickson
- Harvard Medical School, Boston, MA, USA.,Division of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Christopher A Potter
- Harvard Medical School, Boston, MA, USA.,Division of Neuroradiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Division of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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25
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Michael AP, Watson VL, Ryan D, Delfino KR, Bekker SV, Cozzens JW. Effects of 5-ALA dose on resection of glioblastoma. J Neurooncol 2019; 141:523-531. [PMID: 30644009 DOI: 10.1007/s11060-019-03100-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Fluorescence-guided surgery (FGS) with the use of 5-aminolevulinic acid (5-ALA) leads to more extensive resection of high-grade glioma (HGG) and longer overall survival (OS) of patients compared to conventional resection. The purpose of this study is to investigate the effect of 5-ALA dosages on residual tumor volume (RTV) and OS in patients with glioblastoma. METHODS A retrospective cohort study for patients who participated in a phase I and II dose-escalation clinical trial on 5-ALA for resection of HGG. A total of 25 patients were found to have newly diagnosed glioblastoma on histology and enrolled in our study. Patients receiving low doses of 5-ALA (10-30 mg/kg) (n = 6) were compared to those receiving high doses (40-50 mg/kg) (n = 19). Pre- and post-operative contrast enhanced T1W MRI were evaluated with volumetric analysis. RESULTS Median RTV was 0.69 cm3 and 0.00 cm3 in the low and high dose groups respectively (p = 0.975). A gross total resection (GTR) was more likely in the high dose group, though this was not statistically significant. No significant difference was found in median OS between the high and low dose groups (p = 0.6787). CONCLUSIONS High doses of 5-ALA FGS are associated with less RTV and greater probability of GTR. 5-ALA dose was not associated with OS. Further studies with a larger patient cohort are warranted.
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Affiliation(s)
- Alex P Michael
- Division of Neurosurgery, Southern Illinois University School of Medicine, 421 N. 9th Street, Springfield, IL, 62702, USA.
| | - Victoria L Watson
- Division of Neurosurgery, Southern Illinois University School of Medicine, 421 N. 9th Street, Springfield, IL, 62702, USA
| | - Daniel Ryan
- Department of Radiology, Southern Illinois University School of Medicine, 421 N. 9th Street, Springfield, IL, 62702, USA
| | - Kristin R Delfino
- Center for Clinical Research, SIU School of Medicine, 201 E. Madison, P.O. Box 19664, Springfield, IL, 62794-9664, USA
| | - Simon V Bekker
- Department of Radiology, Southern Illinois University School of Medicine, 111 Oakwood Road, East Peoria, IL, 61611, USA
| | - Jeffrey W Cozzens
- Division of Neurosurgery, Southern Illinois University School of Medicine, 421 N. 9th Street, Springfield, IL, 62702, USA
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26
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Post-operative complications of craniotomy and craniectomy. Emerg Radiol 2018; 26:99-107. [PMID: 30255407 DOI: 10.1007/s10140-018-1647-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
Craniotomy and craniectomy are widely performed emergent neurosurgical procedures and are the prescribed treatment for a variety of conditions from trauma to cancer. It is vital for the emergency radiologist to be aware of expected neuroimaging findings in post-craniotomy and craniectomy patients in order to avoid false positives. It is just as necessary to be familiar with postsurgical complications in these patients to avoid delay in lifesaving treatment. This article will review the commonly encountered normal and abnormal findings in post-craniotomy and craniectomy patients. The expected postoperative CT and MRI appearance of these procedures are discussed, followed by complications. These include hemorrhage, tension pneumocephalus, wound/soft tissue infection, bone flap infection and extradural abscesses. Complications specifically related to craniectomies include extracranial herniation, external brain tamponade, paradoxical herniation, and trephine syndrome.
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27
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Huang HW, Yan LM, Yang YL, He X, Sun XM, Wang YM, Zhang GB, Zhou JX. Bi-frontal pneumocephalus is an independent risk factor for early postoperative agitation in adult patients admitted to intensive care unit after elective craniotomy for brain tumor: A prospective cohort study. PLoS One 2018; 13:e0201064. [PMID: 30024979 PMCID: PMC6053234 DOI: 10.1371/journal.pone.0201064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
Postoperative agitation frequently occurs after general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been inadequate. We aimed to investigate the incidence and risk factors for early postoperative agitation in patients after craniotomy, specifically focusing on the association between postoperative pneumocephalus and agitation. Adult intensive care unit admitted patients after elective craniotomy under general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient's computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital length of stay after the surgery were also collected. Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7-16.3%). Body mass index, total intravenous anesthesia, intraoperative fluid intake, intraoperative bleeding and transfusion, consciousness after operation, endotracheal intubation kept at intensive care unit admission and mechanical ventilation, hyperglycemia without a history of diabetes, self-reported pain and postoperative bi-frontal pneumocephalus were used to build a multivariable model. Bi-frontal pneumocephalus and delayed extubation after the operation were identified as independent risk factors for postoperative agitation. After adjustment for confounding, postoperative agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1-28.9, P = 0.048). Our results showed that early postoperative agitation was prevalent among post-craniotomy patients and was associated with adverse outcomes. Improvements in clinical strategies relevant to bi-frontal pneumocephalus should be considered. TRIAL REGISTRATION ClinicalTrials.gov (NCT02318199).
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Affiliation(s)
- Hua-Wei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Mei Yan
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia, China
| | - Yan-Lin Yang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan He
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu-Mei Sun
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Mei Wang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guo-Bin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Cunqueiro A, Scheinfeld MH. Causes of pneumocephalus and when to be concerned about it. Emerg Radiol 2018; 25:331-340. [DOI: 10.1007/s10140-018-1595-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/23/2018] [Indexed: 01/05/2023]
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Packer RA, Rossmeisl JH, Kent MS, Griffin JF, Mazcko C, LeBlanc AK. Consensus recommendations on standardized magnetic resonance imaging protocols for multicenter canine brain tumor clinical trials. Vet Radiol Ultrasound 2018. [PMID: 29522650 DOI: 10.1111/vru.12608] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The National Cancer Institute Comparative Brain Tumor Consortium, Patient Outcomes Working Group, propose a consensus document in support of standardized magnetic resonance imaging protocols for canine brain tumor clinical trials. The intent of this manuscript is to address the widely acknowledged need to ensure canine brain tumor imaging protocols are relevant and have sufficient equivalency to translate to human studies such that: (1) multi-institutional studies can be performed with minimal inter-institutional variation, and (2) imaging protocols are consistent with human consensus recommendations to permit reliable translation of imaging data to human clinical trials. Consensus recommendations include pre- and postcontrast three-dimensional T1-weighted images, T2-weighted turbo spin echo in all three planes, T2*-weighted gradient recalled echo, T2-weighted fluid attenuated inversion recovery, and diffusion weighted imaging/diffusion tensor imaging in transverse plane; field of view of ≤150 mm; slice thickness of ≤2 mm, matrix ≥ 256 for two-dimensional images, and 150 or 256 for three-dimensional images.
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Affiliation(s)
- Rebecca A Packer
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523-1678
| | - John H Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, CA, 95616
| | - John F Griffin
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843
| | - Christina Mazcko
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
| | - Amy K LeBlanc
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892
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30
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Imaging of Acute Head Emergencies. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Murai Y, Ishisaka E, Tsukiyama A, Nakagawa S, Matano F, Tateyama K, Morita A. Reuse of a Reversed "Bone Pad" to Perforate Incompletely Penetrated Burr Holes Created by Automatic-Releasing Cranial Perforators. Oper Neurosurg (Hagerstown) 2017; 13:324-328. [PMID: 28521348 DOI: 10.1093/ons/opw043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 12/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It can be difficult to make complete burr holes using a perforator with automatic releasing systems in cases of a soft diploe or thick calvarial bone. OBJECTIVE To demonstrate the utility of a flipped "bone pad" (BP) in recovery of penetration failure when using an automatic releasing perforator. METHODS For craniotomy or ventricular drainage, the first step is to make 1 or more burr holes using a craniotome. Neurosurgeons sometimes incompletely penetrate the skull using the latest tools. As a countermeasure for such cases, we have developed a simple and practical method. When making a perforation using a high-speed perforator, a round bone piece we call the BP is formed just above the dura. We pulled the BP from a completed burr hole, and placed the reversed BP in position at the bottom of the incompletely perforated burr hole. The BP acted as a new hard surface, preventing the automatic releasing system from activating, and allowed the burr hole to be completed by the craniotome without the need for additional tools. RESULTS With this technique, we have successfully completed 6 out of 7 imperfectly perforated burr holes using a perforator with an automatic releasing system. There were no technique-related complications, such as plunging or dural laceration. CONCLUSIONS The method has the advantage that the BP can be obtained without drilling an additional burr hole, and can be completed without the need for increasing cost, time, or instrument usage.
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Chauhan NS, Banday IA, Morey P, Deshmukh A. External brain tamponade: a rare complication of decompressive craniectomy. Intern Emerg Med 2017; 12:117-118. [PMID: 26983955 DOI: 10.1007/s11739-016-1436-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/04/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Narvir Singh Chauhan
- Department of Radiology, Dr Rajendra Prasad Government Medical College, Set No D- 6, Type V Residence, Kangra, Tanda, Himachal Pradesh, 176001, India.
| | - Irshad Ahmad Banday
- Department of Radiology, Dr Rajendra Prasad Government Medical College, Set No D- 6, Type V Residence, Kangra, Tanda, Himachal Pradesh, 176001, India
| | - Prikshit Morey
- Department of Radiology, Dr Rajendra Prasad Government Medical College, Set No D- 6, Type V Residence, Kangra, Tanda, Himachal Pradesh, 176001, India
| | - Ajinkya Deshmukh
- Department of Radiology, Dr Rajendra Prasad Government Medical College, Set No D- 6, Type V Residence, Kangra, Tanda, Himachal Pradesh, 176001, India
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Gassner HG, Schwan F, Schebesch KM. Minimally invasive surgery of the anterior skull base: transorbital approaches. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 14:Doc03. [PMID: 27453759 PMCID: PMC4940979 DOI: 10.3205/cto000118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.
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Affiliation(s)
- Holger G Gassner
- Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany
| | - Franziska Schwan
- Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany
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Vasung L, Hamard M, Soto MCA, Sommaruga S, Sveikata L, Leemann B, Vargas MI. Radiological signs of the syndrome of the trephined. Neuroradiology 2016; 58:557-568. [DOI: 10.1007/s00234-016-1651-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
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36
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Lee EK, Lee EJ, Kim S, Lee YS. Importance of Contrast-Enhanced Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Various Intracranial Pathologic Conditions. Korean J Radiol 2016; 17:127-41. [PMID: 26798225 PMCID: PMC4720800 DOI: 10.3348/kjr.2016.17.1.127] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022] Open
Abstract
Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea.; Department of Radiology, College of Medicine, Kangwon National University, Chuncheon 24289, Korea
| | - Eun Ja Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Sungwon Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Yong Seok Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
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Wu CJ, Wang Q, Zhang J, Wang XN, Liu XS, Zhang YD, Shi HB. Readout-segmented echo-planar imaging in diffusion-weighted imaging of the kidney: comparison with single-shot echo-planar imaging in image quality. Abdom Radiol (NY) 2016; 41:100-8. [PMID: 26830616 DOI: 10.1007/s00261-015-0615-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the image quality of readout-segmented echo-planar imaging (RS-EPI) and that of standard single-shot echo-planar imaging (SS-EPI) in the kidney in a rat model. MATERIALS AND METHODS Twelve Wistar rats undergoing MRI examinations were imaged with two diffusion-weighted (DW) imaging protocols: a standard SS-EPI and a new RS-EPI protocol, both with a 1.0 × 1.0 × 3.0 mm voxel. The two groups of diffusion-weighted images were independently scored on geometric distortion, image blurring, signal dropout, and the overall image quality by two radiologists. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) were measured on both sequences. Inter-rater agreement (IRA) was evaluated by Fleiss kappa (κ) and inter-class correlation coefficient (ICC) statistics. Comparisons of image qualities were made by Wilcoxon signed-rank test and paired-sample t test. RESULTS Both RS-EPI and SS-EPI had good IRAs in scoring image qualities (κ = 0.607-0.833) and measuring renal ADCs (ICC = 0.828-0.945). Compared to SS-EPI, RS-EPI produced less geometric distortion (median score 1.5 versus 2.5, p < 0.0001), less image blurring (1.75 versus 2.0, p = 0.0003), less signal dropout (1.0 versus 3.0, p = 0.0001), and a lower score in overall image artifacts (4.25 versus 7.25; p < 0.0001). RS-EPI had higher SNR of renal DW images than SS-EPI (p < 0.001). The intra-variability of ADCs in cortex, outer medulla, and inner medulla ranged from 9.6% to 11.1% (Pearson correlation coefficient ρ = 0.675-0.729; p < 0.001) between the two protocols. CONCLUSION We showed that for DWI of the kidney at 1.0 × 1.0 × 3.0 mm(3) voxel sizes, the new protocol provided better image quality than standard SS-EPI protocol.
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Affiliation(s)
- Chen-Jiang Wu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Qing Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xiao-Ning Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xi-Sheng Liu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
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Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog. Case Rep Vet Med 2015. [DOI: 10.1155/2015/372608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 2-year-old female spayed Miniature Dachshund was presented for seizures and right prosencephalic signs. A multiloculated, ring-enhancing mass in the right cerebrum associated with dilation of the right lateral ventricle and brain herniation was seen on magnetic resonance imaging. An irregular calvarial defect with smoothly scalloped edges was seen overlying the mass on computed tomography. The mass was removed via craniectomy and was diagnosed as a chronic brain abscess caused byPeptostreptococcus anaerobius. The patient was maintained on antibiotics for 12 weeks. Follow-up MRI performed 14 weeks after surgery confirmed complete removal of the abscess as well as a contrast-enhancing collection of extra-axial material consistent with a chronic subdural hematoma. The neurologic abnormalities, including seizures, have improved in the 44 months since surgery. Brain abscesses in dogs can have an insidious clinical course prior to causing serious neurologic deterioration. Ventricular entrapment by an intracranial mass can contribute to acute neurologic decline. If surgically accessible, outcome following removal of a brain abscess can be excellent; aerobic and anaerobic bacterial culture should be performed in these cases. Subdural hematoma can occur following removal of a large intracranial mass. Growing skull fractures can occur in dogs but may not require specific surgical considerations.
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Grabowski MM, Recinos PF, Nowacki AS, Schroeder JL, Angelov L, Barnett GH, Vogelbaum MA. Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg 2014; 121:1115-23. [DOI: 10.3171/2014.7.jns132449] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The impact of extent of resection (EOR) on survival for patients with glioblastoma (GBM) continues to be a point of debate despite multiple studies demonstrating that increasing EOR likely extends survival for these patients. In addition, contrast-enhancing residual tumor volume (CE-RTV) alone has rarely been analyzed quantitatively to determine if it is a predictor of outcome. The purpose of this study was to evaluate the effect of CE-RTV and T2/FLAIR residual volume (T2/F-RV) on overall survival.
Methods
A retrospective review of 128 patients who underwent primary resection of supratentorial GBM followed by standard radiation/chemotherapy was undertaken utilizing quantitative, volumetric analysis of pre- and postoperative MR images. The results were compared with clinical data obtained from the patients' medical records.
Results
At analysis, 8% of patients were alive, and no patients were lost to follow-up. The overall median survival was 13.8 months, with a median Karnofsky Performance Scale (KPS) score of 90 at presentation. The median contrast-enhancing preoperative tumor volume (CE-PTV) was 29.0 cm3, and CE-RTV was 1.2 cm3, equating to a 95.8% median EOR. The median T2/F-RV was 36.8 cm3. CE-PTV, CE-RTV, T2/F-RV, and EOR were all statistically significant predictors of survival when controlling for age and KPS score. A statistically significant benefit in survival was seen with a CE-RTV less than 2 cm3 or an EOR greater than 98%. Evaluation of the volumetric analysis methodology was performed by observers of varying degrees of experience—an attending neurosurgeon, a fellow, and a medical student. Both the medical student and fellow recorded correlation coefficients of 0.98 when compared with the attending surgeon's measured volumes of CE-PTV, while for CE-RTV, correlation coefficients of 0.67 and 0.71 (medical student and fellow, respectively) were obtained.
Conclusions
CE-RTV and EOR were found to be significant predictors of survival after GBM resection. CERTV was the more significant predictor of survival compared with EOR, suggesting that the volume of residual contrast-enhancing tumor may be a more accurate and meaningful reflection of the pathobiology of GBM.
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Affiliation(s)
| | - Pablo F. Recinos
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
| | - Amy S. Nowacki
- 2Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jason L. Schroeder
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
| | - Lilyana Angelov
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
| | - Gene H. Barnett
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
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Sarubbo S, Latini F, Ceruti S, Chieregato A, d'Esterre C, Lee TY, Cavallo M, Fainardi E. Temporal changes in CT perfusion values before and after cranioplasty in patients without symptoms related to external decompression: a pilot study. Neuroradiology 2014; 56:237-43. [PMID: 24430116 DOI: 10.1007/s00234-014-1318-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/03/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little is known about hemodynamic disturbances affecting cerebral hemispheres in traumatic brain injury (TBI) after cranioplasty. METHODS We prospectively investigated six stable TBI patients who underwent cranioplasty more than 90 days after effective decompressive craniectomy. Computerized tomography perfusion (CTP) studies and evaluation of clinical outcome were performed for each patient before cranioplasty and at 7 days and 3 months after surgery. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in multiple cortical circular regions positioned in cranioplasty-treated and contralateral hemispheres. RESULTS Neither complications associated with cranioplasty nor changes in outcome were observed. On the treated side, CBF and CBV values were higher before and 7 days after cranioplasty than at 3 months after surgery, whereas MTT values were lower at 7 days than at 3 months after surgical treatment. CONCLUSIONS Our results indicate that cortical perfusion progressively declines in the cranioplasty treated hemisphere but remains stable in the contralateral hemisphere after surgery and suggest that CTP can represent a promising tool for a longitudinal analysis of hemodynamic abnormalities occurring in TBI patients after cranioplasty. In addition, these data imply a possible role of cranioplasty in restoring flow to meet the prevailing metabolic demand.
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Affiliation(s)
- Silvio Sarubbo
- Neurosurgery Unit, Department of Neurosciences, "S. Chiara" Hospital, APSS Trento, Trento, Italy
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Computed Tomography Imaging Manifestations of Commonly Used Materials in Posttraumatic Craniofacial Repair. J Comput Assist Tomogr 2014; 38:890-7. [PMID: 25119065 DOI: 10.1097/rct.0000000000000138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cheatle J, Aldrich A, Thorell WE, Boska MD, Kielian T. Compartmentalization of immune responses during Staphylococcus aureus cranial bone flap infection. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 183:450-8. [PMID: 23747950 DOI: 10.1016/j.ajpath.2013.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/02/2013] [Accepted: 04/25/2013] [Indexed: 12/22/2022]
Abstract
Decompressive craniectomy is often required after head trauma, stroke, or cranial bleeding to control subsequent brain swelling and prevent death. The infection rate after cranial bone flap replacement ranges from 0.8% to 15%, with an alarming frequency caused by methicillin-resistant Staphylococcus aureus, which is problematic because of recalcitrance to antibiotic therapy. Herein we report the establishment of a novel mouse model of S. aureus cranial bone flap infection that mimics several aspects of human disease. Bacteria colonized bone flaps for up to 4 months after infection, as revealed by scanning electron microscopy and quantitative culture, demonstrating the chronicity of the model. Analysis of a human cranial bone flap with confirmed S. aureus infection by scanning electron microscopy revealed similar structural attributes as the mouse model, demonstrating that it closely parallels structural facets of human disease. Inflammatory indices were most pronounced within the subcutaneous galeal compartment compared with the underlying brain parenchyma. Specifically, neutrophil influx and chemokine expression (CXCL2 and CCL5) were markedly elevated in the galea, which demonstrated substantial edema on magnetic resonance images, whereas the underlying brain parenchyma exhibited minimal involvement. Evaluation of immune mechanisms required for bacterial containment and inflammation revealed critical roles for MyD88-dependent signaling and neutrophils. This novel mouse model of cranial bone flap infection can be used to identify key immunologic and therapeutic mechanisms relevant to persistent bone flap infection in humans.
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Affiliation(s)
- Joseph Cheatle
- Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
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McNamara MG, Sahebjam S, Mason WP. Anaplastic oligodendroglioma: advances and treatment options. Curr Treat Options Neurol 2013; 15:289-301. [PMID: 23344797 DOI: 10.1007/s11940-013-0218-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OPINION STATEMENT The optimal treatment strategy for anaplastic oligodendroglial (AO) tumors is evolving. Molecular profiling of oligodendrogliomas have shown distinctive genetic patterns characterized by combined deletions of chromosome arms 1p and 19q, O(6)-methylguanine methyltransferase (MGMT) methylation, and isocitrate dehydrogenase 1 (IDH1) mutations; they are all prognostic factors for patients with AO. In addition, a strong association has also been found between the CpG island hypermethylation phenotype (CIMP) status and MGMT promoter methylation. Long term follow up data of the Radiation Therapy Oncology Group (RTOG) 9402 and the European Organisation for Research and Treatment of Cancer (EORTC) 26951 studies demonstrate clear evidence that for patients with codeleted 1p19q AO, early chemotherapy with radiation offers a significant improvement in overall survival compared with early radiation, even with salvage chemotherapy at tumor relapse, and thus establishes the 1p19q allelic loss as a predictive marker distinct from tumors without the chromosome change. Radiotherapy alone is no longer considered an adequate treatment for this patient population. In cases with no 1p19q deletion, most neuro-oncologists recommend incorporating radiotherapy into the upfront treatment strategy. However, there are still unanswered questions regarding whether upfront chemotherapy, omitting/deferring radiotherapy, in the desire to avoid late neurocognitive toxicity of radiotherapy should be the initial therapy for AO tumors with codeleted 1p19q, or whether temozolomide, an oral agent with a better toxicity profile, can be substituted for procarbazine, lomustine, and vincristine (PCV). Further studies are warranted and the increasing understanding of molecular pathways involved may lead to more selective therapeutic targets in the future.
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Affiliation(s)
- Mairéad G McNamara
- Pencer Brain Tumor Centre, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
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Khan M, Patel S, Singh A. Imaging of Acute Head Emergencies. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vogel TW, Dlouhy BJ, Howard MA. Don't take the plunge: avoiding adverse events with cranial perforators. J Neurosurg 2011; 115:570-5. [DOI: 10.3171/2011.3.jns101310] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The object of this study was to evaluate the causes of plunging events associated with automatic-releasing cranial perforators at the authors' institution.
Methods
The authors analyzed a consecutive series of 1652 cranial procedures involving one type of automaticreleasing cranial perforator over a 2-year period. Plunging occurrences were recorded for 2 drill speeds: 1000 rpm in the 1st year and 800 rpm during the 2nd year. Intraoperative observations, neuroimaging studies, and clinical data were evaluated for each plunging event.
Results
The authors identified 9 plunging events for an overall incidence of 0.54%. In the 1st year, they identified 2 plunging events at a speed of 1000 rpm for an incidence of 0.19%. In an effort to reduce this occurrence, the speed of the drill was lowered to 800 rpm. There were 7 additional events, for a significantly increased incidence of 1.16% (p = 0.014, Fisher exact test) after the change was implemented. These cases spanned a number of procedures in adults and pediatric patients, including ventriculostomy placement, craniotomies for tumor resection, tumor biopsy, and endoscopic third ventriculostomy. Despite plunging, no immediate postoperative complications were noted on clinical examination.
Conclusions
While technology continues to improve cranial perforator performance, the use of such a device is still associated with a risk of complications causing dural lacerations and injury to the underlying cortex. Decreasing the drill speed may not decrease the incidence of plunging.
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