Intraoperative use of cone-beam computed tomography for the safe epidural blood patch: Technical case report

Background: Epidural blood patch (EBP) is a common method utilized to treat intracranial hypotension, and secondarily, to treat unintentional dural puncture. The authors propose an effective technique for correct epidural needle positioning during EBP using cone-beam computed tomography (CB-CT) images. Case Description: A 31-year-old female underwent an EBP. Following confirmation of the spinal level of the cerebrospinal fluid leakage, the ideal trajectory for the proposed EBP was assessed from the entry point on the skin to the spinolaminar line under CB-CT imaging. The epidural needle was then gently advanced along the appropriate trajectory. At the 10 mm mark, behind the spinolaminar line, the inner needle was removed. This allowed for slow advancement of the outer needle until its tip reached the epidural space, and its location was confirmed by the “loss of resistance to the saline technique.” Using biplane epidurography, the spread of dye within the epidural space for appropriate localization was confirmed. In this case study, the patient’s postural headache immediately improved. Conclusion: Using the CB-CT technique described, a patient successfully underwent EBP without complications.

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Spontaneous Cervical (C1–C2) Cerebrospinal Fluid Leakage Repaired with Computed Tomography-Guided Cervical Epidural Blood Patch

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2010.04.010 ◽

2010 ◽

Vol 40 (3) ◽

pp. e9-e12 ◽

Cited By ~ 6

Author(s):

Massimo Allegri ◽

Francesco Lombardi ◽

Paola Scagnelli ◽

Mario Corona ◽

Cristina E. Minella ◽

...

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Epidural Blood Patch ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage ◽

Blood Patch

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Volumetric Measurements of Brain Shift Using Intraoperative Cone-Beam Computed Tomography: Preliminary Study

Operative Neurosurgery ◽

10.1227/neu.0000000000000999 ◽

2015 ◽

Vol 12 (1) ◽

pp. 4-13 ◽

Cited By ~ 7

Author(s):

Vitor Mendes Pereira ◽

Iris Smit-Ockeloen ◽

Olivier Brina ◽

Drazenko Babic ◽

Marcel Breeuwer ◽

...

Keyword(s):

Computed Tomography ◽

Vector Field ◽

Cone Beam Computed Tomography ◽

Vector Fields ◽

Preoperative Planning ◽

Cone Beam ◽

Cerebrospinal Fluid Leakage ◽

Neurosurgical Procedures ◽

Brain Shift ◽

Deformation Vector Field

Abstract BACKGROUND Cerebrospinal fluid leakage and ventricular compression during open surgery may lead to brain deformation called brain shift. Brain shift may affect intraoperative navigation that is based on image-based preoperative planning. Tools to correct or predict these anatomic modifications can be important to maintain precision during open guided neurosurgery. OBJECTIVE To obtain a reliable intraoperative volumetric deformation vector field describing brain shift during intracranial neurosurgical procedures. METHODS We acquired preoperative and intraoperative cone-beam computed tomography enhanced with intravenous injection of iodine contrast. These data sets were preprocessed and elastically registered to obtain the volumetric brain shift deformation vector fields. RESULTS We obtained the brain shift deformation vector field in 9 cases. The deformation fields proved to be highly nonlinear, particularly around the ventricles. Interpatient variability was considerable, with a maximum deformation ranging from 8.1 to 26.6 mm and a standard deviation ranging from 0.9 to 4.9 mm. CONCLUSION Contrast-enhanced cone-beam computed tomography provides a feasible technique for intraoperatively determining brain shift deformation vector fields. This technique can be used perioperatively to adjust preoperative planning and coregistration during neurosurgical procedures.

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Percutaneous Image-Guided Intracranial Surgical Tool Placement in a Simulated Brain Tumor Using Flat-Panel Cone-Beam Computed Tomography (FP-CBCT) and Digital Fluoroscopy: A Feasibility Study

Skull Base ◽

10.1055/s-2008-1093129 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

Beverly Aagaard-Kienitz ◽

Brian Nett ◽

Andrew Bauer ◽

Mustafa Baskaya ◽

Guang-Hong Chen

Keyword(s):

Computed Tomography ◽

Brain Tumor ◽

Feasibility Study ◽

Cone Beam Computed Tomography ◽

Cone Beam ◽

Flat Panel ◽

Digital Fluoroscopy ◽

Image Guided ◽

Surgical Tool

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Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report

Journal Of Cardiovascular, Neurovascular & Stroke ◽

10.32896/cvns.v1n1.16-18 ◽

2019 ◽

Vol 1 (1) ◽

pp. 16-18 ◽

Cited By ~ 1

Author(s):

Norafida Bahari ◽

Nik Azuan Nik Ismail ◽

Jegan Thanabalan ◽

Ahmad Sobri Muda

Keyword(s):

Computed Tomography ◽

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Cone Beam Computed Tomography ◽

Diagnostic Value ◽

Cone Beam ◽

Brain Arteriovenous Malformation ◽

Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

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