Setting up an imaging center, adding computed tomographic, magnetic resonance, and an angiography suite to vascular labs

Abstract OBJECTIVE Although a few studies have quantified errors in the implantation of deep brain stimulation electrodes into the subthalamic nucleus (STN), a significant trend in error direction has not been reported. We have previously found that an error in axial plane, which is of most concern because it cannot be compensated for during deep brain stimulation programming, had a posteromedial trend. We hypothesized that this trend results from a predominance of a directionally oriented error factor of brain origin. Accordingly, elimination of nonbrain (technical) error factors could augment this trend. Thus, implantation accuracy could be improved by anterolateral compensation during target planning. METHODS Surgical technique was revised to minimize technical error factors. During 22 implantations, targets were selected on axial magnetic resonance imaging scans up to 1.5 mm anterolateral from the STN center. Using fusion of postoperative computed tomographic and preoperative magnetic resonance imaging scans, implantation errors in the axial plane were obtained and compared with distances from the lead to the STN to evaluate the benefit of anterolateral compensation. RESULTS Twenty errors and the mean error had a posteromedial direction. The average distances from the lead to the target and to the STN were 1.7 mm (range, 0.8–3.1 mm) and 1.1 mm (range, 0.1–1.9 mm), respectively. The difference between the 2 distances was significant (paired t test, P < 0.0001). The lower parts of the lead were consistently bent in the posteromedial direction on postoperative scout computed tomographic scans, suggesting that a brain-related factor is responsible for the reported error. CONCLUSION Elimination of the technical factors of error during STN deep brain stimulation implantation can result in a consistent posteromedial error. Implantation accuracy may be improved by compensation for this error in advance.

Download Full-text

Stereotactic Intratumoral Photodynamic Therapy for Recurrent Malignant Brain Tumors

Neurosurgery ◽

10.1227/00006123-199111000-00008 ◽

1991 ◽

Vol 29 (5) ◽

pp. 688-696 ◽

Cited By ~ 46

Author(s):

Stephen K. Powers ◽

Sharon S. Cush ◽

Diana L. Walstad ◽

Lester Kwock

Keyword(s):

Photodynamic Therapy ◽

Magnetic Resonance ◽

Malignant Gliomas ◽

Signs And Symptoms ◽

Resonance Spectroscopy ◽

Normal Brain ◽

Hematoporphyrin Derivative ◽

Neurological Sequelae ◽

Computed Tomographic ◽

Before And After

Abstract Photodynamic therapy (PDT) using purified hematoporphyrin derivative and stereotactic intratumorally implanted optical laser fiber(s) was used to treat patients with recurrent malignant gliomas and metastatic melanoma of the brain. Tumor response to PDT was evaluated by recording changes in the volume and pattern of tumor enhancement between computed tomographic and magnetic resonance imaging scans done before and after PDT, metabolic changes in tumor tissue by31 P magnetic resonance spectroscopy, and patient outcome. Toxicity of PDT to brain was evaluated on the basis of changes in the patients' neurological examinations and correlated with changes in brain adjacent to tumor seen on postoperative imaging studies. Dramatic tumor responses to PDT were seen in all gliomas, but no response of tumor to treatment was seen with melanoma. Transient signs and symptoms of increased peritumoral cerebral edema caused by PDT were seen in all patients. Two patients suffered permanent neurological sequelae, monocular blindness and a partial visual field defect, as a result of treatment. Two patients with recurrent anaplastic astrocytomas remain in remission at 45 and 35 weeks after PDT. We conclude that intratumoral photoradiation therapy of hematoporphyrin derivative-photosensitized malignant gliomas effectively produces necrosis of the solid component of malignant gliomas: however, intratumoral photoradiation may not reach the portion of tumor that invades normal brain.

Download Full-text

Comparison of three-dimensional volume-targeted thin-slab FIESTA magnetic resonance angiography and 64-multidetector computed tomographic angiography for the identification of proximal coronary stenosis

International Journal of Cardiology ◽

10.1016/j.ijcard.2012.08.058 ◽

2013 ◽

Vol 167 (6) ◽

pp. 2969-2976 ◽

Cited By ~ 3

Author(s):

Liuquan Cheng ◽

Lin Ma ◽

Paul Schoenhagen ◽

Huiyi Ye ◽

Xin Lou ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Coronary Stenosis ◽

Three Dimensional ◽

Computed Tomographic Angiography ◽

Thin Slab ◽

Computed Tomographic ◽

Tomographic Angiography

Download Full-text

Computed Tomographic Angiography or Magnetic Resonance Angiography for Detection of Intracranial Vascular Malformations in Patients With Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.114.007364 ◽

2015 ◽

Vol 46 (1) ◽

Author(s):

Colin B. Josephson ◽

Philip M. White ◽

Ashma Krishan ◽

Rustam Al-Shahi Salman

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Intracerebral Hemorrhage ◽

Vascular Malformations ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

Download Full-text

Primary Intrasellar Microgerminoma Detected by Magnetic Resonance Imaging: Case Report

Neurosurgery ◽

10.1227/00006123-198909000-00024 ◽

1989 ◽

Vol 25 (3) ◽

pp. 458-462 ◽

Cited By ~ 16

Author(s):

Mariko Oishi ◽

Takaharu Iida ◽

Misako Koide ◽

Yoshiharu Akazawa ◽

Yoshie Azuma ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Hormone Secretion ◽

Growth Hormone Secretion ◽

Sella Turcica ◽

Posterior Lobe ◽

Resonance Imaging ◽

Pituitary Fossa ◽

Computed Tomographic ◽

Initial Symptoms

Abstract A case of primary intrasellar germinoma in a 24-year-old woman is presented. Her initial symptoms were diabetes insipidus and headaches. The neurological examination found no abnormalities, but the endocrinological examination disclosed a deficiency in growth hormone secretion. Her skull x-ray revealed a normal sella turcica, and a computed tomographic scan revealed no abnormal mass in the pituitary fossa, but a slightly enlarged stalk. Magnetic resonance imaging revealed a small tumor in the posterior lobe. Transsphenoidal exploration revealed a germinoma in the posterior pituitary lobe. Six cases of primary intrasellar germinoma, including our case, were reviewed. Our case is considered to be the smallest intrasellar germinoma yet reported.

Download Full-text