Variables affecting the accuracy of stereotactic localization using computerized tomography

1993 ◽  
Vol 79 (5) ◽  
pp. 667-673 ◽  
Author(s):  
Richard D. Bucholz ◽  
Hector W. Ho ◽  
Jason P. Rubin
Keyword(s):  
Computerized Tomography ◽  
Neurosurgical Procedures ◽  
Slice Thickness ◽  
Laptop Computer ◽  
Content Type ◽  
Mean Error ◽  
Critical Areas ◽  
Stereotactic Localization ◽  
The Brain ◽  
Fine Print

✓ Stereotactic localization using computerized tomography (CT) is increasingly employed to guide neurosurgical procedures in crucial areas of the brain such as the brain stem. This technique allows the surgeon to resect a lesion in its entirety while sparing critical areas of the brain. Thus, the parameters used for scanning should be selected for maximum accuracy. While the small pixel size of CT scanners suggests a high degree of precision in localization, there have been few systematic studies of this accuracy. The authors have studied the amount of error in localization created by variables such as CT scan thickness, interscan spacing, size of lesion, and method of computation when using the Brown-Roberts-Wells (BRW) stereotactic system. Over 1000 CT scans were made of a phantom composed of spheres of differing diameter and location. The CT slice thickness was varied from 1.5 to 5.0 mm, and interscan spacing was varied from 0.5 to 3.0 mm. The coordinates of the center of the spheres were calculated independently using the laptop computer supplied with the unit and also by a stereotactic computer which automatically calculates the center of the fiducials. The actual BRW coordinates of the sphere center were obtained using the phantom base and were then compared to the computer-calculated coordinates to determine error in localization. Variables with a significant effect on error included the scan thickness, interscan spacing, and sphere size. The mean error decreased 23% as the scan thickness decreased from 5.0 to 1.5 mm and 45% as the interscan spacing decreased from 3.0 to 0.5 mm. Mean error was greatest for the smallest sphere sizes. The two computational methods did not differ in error. This study suggests that, for critical areas of the brain or for small lesions, a scan thickness of 1.5 mm and interscan spacing of 0.5 mm should be employed.

Multiple giant hydatid cysts of the brain

1982 ◽  
Vol 57 (3) ◽  
pp. 413-415 ◽  
Author(s):  
Ajay Sharma ◽  
Jacob Abraham
Keyword(s):  
Computerized Tomography ◽  
Hydatid Disease ◽  
Rare Case ◽  
The Body ◽  
Hydatid Cysts ◽  
Content Type ◽  
Multiple Primary ◽  
The Right ◽  
The Brain ◽  
Fine Print

✓ A rare case of multiple primary hydatid cysts of the brain is reported in a 9-year-old girl. There were five cysts, occupying most of the right supratentorial region. The biggest cyst measured 9 cm across, while the smallest one was 4.5 cm in diameter. The diagnosis was based on computerized tomography findings. The patient did not have any evidence of hydatid disease elsewhere in the body. The delivery of all the cysts resulted in the dramatic neurological recovery of this patient.

Tuberculoma presenting as an en plaque meningioma

1996 ◽  
Vol 85 (4) ◽  
pp. 685-688 ◽  
Author(s):  
Jerry Bauer ◽  
Roger F. Johnson ◽  
Joseph M. Levy ◽  
Donald V. Pojman ◽  
John R. Ruge
Keyword(s):  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Brain Parenchyma ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Multiple Lesions ◽  
Intracranial Tuberculoma ◽  
The Brain ◽  
Fine Print

✓ Intracranial tuberculomas generally present as either solitary or multiple lesions in the brain parenchyma. They are characterized by a ring-enhancing area on either computerized tomography scans or magnetic resonance images. A case is presented in which an intracranial tuberculoma was dural based and had an appearance similar to an en plaque meningioma.

Primary intracranial epidermoid carcinoma

1979 ◽  
Vol 50 (6) ◽  
pp. 830-833 ◽  
Author(s):  
Yoshiki Nosaka ◽  
Seigo Nagao ◽  
Kazuo Tabuchi ◽  
Akira Nishimoto
Keyword(s):  
Brain Stem ◽  
Computerized Tomography ◽  
Cerebellopontine Angle ◽  
Epidermoid Carcinoma ◽  
Malignant Tissue ◽  
Content Type ◽  
The Right ◽  
Intracranial Epidermoid ◽  
The Brain ◽  
Fine Print

✓ A case is presented of primary intracranial epidermoid carcinoma in the right cerebellopontine angle which was visualized as a homogeneously enhanced mass on computerized tomography. At autopsy the malignant tissue was found to have invaded the brain stem.

Computerized tomography in hydatid cyst of the brain

1978 ◽  
Vol 49 (3) ◽  
pp. 408-411 ◽  
Author(s):  
Kazem Abbassioun ◽  
Hamid Rahmat ◽  
Nosrat O. Ameli ◽  
Mansour Tafazoli
Keyword(s):  
Differential Diagnosis ◽  
Hydatid Cyst ◽  
Computerized Tomography ◽  
Hydatid Disease ◽  
Preoperative Diagnosis ◽  
Cystic Lesions ◽  
Content Type ◽  
The Brain ◽  
Ct Features ◽  
Fine Print

✓ From among 1500 patients who underwent computerized tomography (CT) during an 18-month period, five cases of hydatid disease of the brain were diagnosed. The preoperative diagnosis is of paramount importance as the cyst has to be removed unruptured. The CT features of this condition are practically pathognomonic. The authors discuss the CT findings in these cases and differential diagnosis with other cystic lesions of the brain. The help that this safe and sure method of investigation gives to attain preoperative diagnosis is emphasized.

Intraoperative use of real-time ultrasonography in neurosurgery

1982 ◽  
Vol 57 (2) ◽  
pp. 157-163 ◽  
Author(s):  
William F. Chandler ◽  
James E. Knake ◽  
John E. McGillicuddy ◽  
Kevin O. Lillehei ◽  
Terry M. Silver
Keyword(s):  
Arteriovenous Malformation ◽  
Real Time ◽  
Operating Room ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Brain Surface ◽  
The Brain ◽  
Real Time Ultrasonography ◽  
Fine Print

✓ The authors' experience with the intraoperative use of real-time ultrasonography during 21 neurosurgical procedures is reported. These procedures include neoplasm surgery in 18 cases, treatment of an arteriovenous malformation in one case, and ventricular catheter placement for hydrocephalus in two cases. In each of the neoplasm cases, the tumors were imaged just as well through the intact dura as on the brain surface itself. There were no cases in which the pathology could not easily be identified. The use of portable intraoperative ultrasonography in sterile coverings has proven to be extremely useful in localizing small subcortical neoplasms, as well as locating the solid and cystic portions of deep lesions. It has assisted in guiding needles for both biopsy and aspiration. It has also accurately identified and guided Silastic catheters during their placement in the ventricular system in cases of hydrocephalus. The authors have found real-time ultrasonography to be an important new tool in the operating room and will continue to rely on its imaging ability during selected procedures in the future.

Supratentorial and parafalcial subdural empyema diagnosed by computerized tomography

1981 ◽  
Vol 54 (1) ◽  
pp. 105-107 ◽  
Author(s):  
Bernardo Borovich ◽  
Jacob Braun ◽  
Silvia Honigman ◽  
Henry Z. Joachims ◽  
Eli Peyser
Keyword(s):  
Computerized Tomography ◽  
Subdural Empyema ◽  
Subdural Space ◽  
Carotid Angiography ◽  
Successful Result ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ A case is presented in which computerized tomography (CT) demonstrated a supratentorial and parafalcial purulent collection. However, neither carotid angiography nor CT revealed the small scattered pockets of pus that were found over the convexity at operation. The entire subdural space was exposed by a wide craniectomy, permitting adequate subdural drainage and decompression of the brain. It is thought that thorough drainage of the entire subdural space is crucial for the attainment of a successful result in a singlestage operation.

Focal histiocytosis X of the parietal lobe

1980 ◽  
Vol 52 (3) ◽  
pp. 431-433 ◽  
Author(s):  
Arfa Khan ◽  
John D. Fulco ◽  
Ashok Shende ◽  
Alan Rosenthal ◽  
Joseph A. Marc
Keyword(s):  
Computerized Tomography ◽  
Parietal Lobe ◽  
Histiocytosis X ◽  
Review Of The Literature ◽  
Content Type ◽  
The Brain ◽  
Tomography Scan ◽  
Space Occupying Lesion ◽  
Fine Print

✓ The authors describe a case of histiocytosis X of the parietal lobe presenting as a space-occupying lesion on a computerized tomography scan of the brain. The clinical, radiographic, and therapeutic aspects of the case are discussed. A brief review of the literature is presented.

Intracerebral infusion of thrombin as a cause of brain edema

1995 ◽  
Vol 83 (6) ◽  
pp. 1045-1050 ◽  
Author(s):  
Kevin R. Lee ◽  
A. Lorris Betz ◽  
Richard F. Keep ◽  
Thomas L. Chenevert ◽  
Seoung Kim ◽  
...  
Keyword(s):  
Brain Edema ◽  
Brain Parenchyma ◽  
Thrombin Inhibitor ◽  
Neurosurgical Procedures ◽  
Edema Formation ◽  
Content Type ◽  
The Right ◽  
The Brain ◽  
Brain Water ◽  
Fine Print

✓ Purified thrombin from an exogenous source is a hemostatic agent commonly used in neurosurgical procedures. The toxicity of thrombin in the brain, however, has not been examined. This study was performed to assess the effect of thrombin on brain parenchyma, using the formation of brain edema as an indicator of injury. Ten µl of test solution was infused stereotactically into the right basal ganglia of rats. The animals were sacrificed 24 hours later, and the extent of brain edema and ion content were measured. Concentrations of human thrombin as low as 1 U/µl resulted in a significant increase in brain water content. Rats receiving 10 U/µl had a mortality rate of 33% compared to no mortality in the groups receiving smaller doses. Thrombin-induced brain edema was inhibited by a specific and potent thrombin inhibitor, hirudin. A medical grade of bovine thrombin commonly used in surgery also caused brain edema when injected at a concentration of 2 U/µl. Edema formation was prevented by another highly specific thrombin inhibitor, Nα-(2-Naphthalenesulfonylglycyl)-4-dl-phenylalaninepiperidide (α-NAPAP). Thrombininduced brain edema was accompanied by increases in brain sodium and chloride contents and a decrease in brain potassium content. Changes in brain ions were inhibited by both hirudin and α-NAPAP, corresponding to the inhibition of brain water accumulation. This study shows that thrombin causes brain edema when infused into the brain at concentrations as low as 1 U/µl, an amount within the range of concentrations used for topical hemostasis in neurosurgery.

Brain-tumor imaging using radiopaque perfluorocarbon

1983 ◽  
Vol 58 (5) ◽  
pp. 650-653 ◽  
Author(s):  
Nicholas J. Patronas ◽  
Javad Hekmatpanah ◽  
Kunio Doi
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Contrast Agent ◽  
Contrast Medium ◽  
Computerized Tomography ◽  
Tumor Imaging ◽  
Content Type ◽  
X Ray ◽  
The Brain ◽  
Fine Print

✓ Perfluorocarbon, a new tumor-seeking x-ray contrast agent, was injected into three rats with experimental brain tumors. After 1 to 3 days the rats were sacrificed, and the brains were removed and subjected to x-ray study. All showed dense radiopaque areas which correlated with the size and shape of the corresponding brain tumors. Conversely, none of the radiograms taken of the brain tumor in five rats receiving no perfluorocarbon (control animals) showed similar increased density. These findings suggest that perfluorocarbon may serve a useful role as a contrast medium for computerized tomography studies of brain tumors in man.

Waterjet dissection of the brain: experimental and first clinical results

1998 ◽  
Vol 89 (5) ◽  
pp. 861-864 ◽  
Author(s):  
Jürgen Piek ◽  
Christian Wille ◽  
Rolf Warzok ◽  
Michael-Robert Gaab
Keyword(s):  
Clinical Results ◽  
New Method ◽  
Surrounding Tissue ◽  
Histological Evaluation ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
New Device ◽  
Waterjet Dissection ◽  
The Brain ◽  
Fine Print

✓ Control of bleeding during dissection is a problem that is still not completely resolved in neurosurgical procedures. To overcome this problem in some settings, the authors, in close collaboration with their institution, developed a new device for blunt dissection of brain tumors that is based on a waterjet technique. This report describes their first experimental and clinical experience with this new method. Numerous cutting experiments were performed in porcine cadaver brains. The best results were obtained using pressures from 4 to 6 bars with a 100-jxm tip, which produced very small, precise cuts. Histological evaluation showed no disruption or vacuolization of the surrounding tissue. The authors have used the new device in nine patients (seven with gliomas and two undergoing temporal lobe resections for epilepsy), and no complications have been observed. The waterjet device allowed dissection of the brain tissue while even small exposed vessels were spared injury. The instrument was found to be easy to use. Future investigations will concentrate on adapting this new method to endoscopic surgery and evaluating fluids with low surface tension to avoid foaming and bubbling during open surgery.

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