Nuro

NEUROSURGICALINVESTIGATIONS

NEUROSURGICAL INVESTIGATIONS
Cerebrospinal fluid examination CSF imaging study Plain X-rays CT scan MRI Cranial and Spinal Angiography. Myelography Positron emision tomography MR spectroscopy MR tractography Electroencephalography (EEG). Nerve conduction Studies/Electromyography (EMG). Nerve and muscle biopsy Hormonal tests

CEREBROSPINAL FLUID(CSF) INVESTIGATION

LUMBAR PUNCTURE

LUMBAR PUNCTURE

LUMBAR PUNCTURE

LUMBAR PUNCTURE INDICATIONS

suspected meningitis subarachnoid hemorrhage SAH cytology in neoplastic diseases measurement of intracranial pressure ICP therapeutic CSF aspiration (benign raised intracranial pressure)(pseudotumor cerebri). conventional myelography by contrast injection Spinal anesthesia

MEASUREMENT OF INTRACRANIAL PRESSURE

CONTRAINDICATIONS TO LUMBAR PUNCTURE

COMPLICATIONS OF LUMBAR PUNCTURE

Post spinal headache triad treatment Cerebellar tonsillar herniation if there is raised ICP. Injury to the neural structure Back pain infection and meningitis Implantation of cutaneous tissue with subsequent epidermoid cyst Bleeding

IMAGING INVESTIGATIONS

Plain X-rays CT scan MRI Angiography. Myelography Positron emmision tomography MR spectroscopy MR tractography

PLAIN X-RAY

PLAIN X-RAYS OF THE SPINE
Particular note should be taken of: Vertebral alignment. Presence of degenerative disease with narrowing of the neural foramina and spinal canal. Evidence of metastatic tumour with erosion or sclerosis of the vertebral body, pedicles or lamina. Enlargement of a neural foramen indicating a spinal schwannoma. Congenital abnormalities such as spina bifida.

COMPUTED TOMOGRAPHY (CT)SCAN

Indications for Computed Tomography in Neurosurgery: Cranial CT: Diagnosis of acute neurosurgical lesions in the head and spine, including: Skull and spinal fractures. Intracranial hemorrhage: like extradural haematoma,subdural haematoma, intracerebral haematoma. Oedema: brain oedema whether due to trauma or other cause. Mass lesions: mainly brain mass lesions like tumours and brain abscess. Hydrocephalus Stroke: differentiate between infarction and intracranial haemorrhage.

INDICATIONS FOR MAGNETIC RESONANCE IMAGING

Intracranial tumous. cerebral abscess. Arteriovenous malformations. Venous sinus thrombosis. Craniospinal abnormalities such as the Chiari malformation. Syringomyelia. Spinal tumours. Disc prolapse (including cervical, lumbar and dorsal disc prolapse). Spinal canal stenosis (lumbar or cervical stenosis) and cervical myelopathy.

CT IS BETTER THAN MRI

Diagnoses of bone related pathologies like fractures and bone tumors. Better for acute hemorhagic lesions Less time is needed to perform CT than MRI (few minutes) critically ill patients.

MRI IS BETTER THAN CT

Sellar pathology (pituitary) Posterior fossa tumours (cerebellar and brain stem tumours). Spinal cord pathology (compression and tumours), and one can do myelography with non invasive method (no need for lumbar puncture). Infarction can be diagnosed as early as few hours whereas CT needs 48 hours to diagnose it. No ionizing radiation. Can be repeated safely

CT VERSUS MRI

CONTRAINDICATIONS TO MRI
Metallic foreign bodies anywhere in the body like plating and screwing, shells ,cardiac pace maker, intracranial clipsClaustrophobia.Gross obesityUncontrolled movement disorders (Parkinson’s disease).Respiratory disease that require assisted ventilation or carry risk of apnea

CRANIAL AND SPINAL ANGIOGRAPHY

images of blood vessels … arteriovenous malformations and aneurysms

ELECTROENCEPHALOGRAPHY(EEG)

ELECTROENCEPHALOGRAPHY(EEG)

NERVE CONDUCTION STUDIES/ ELECTROMYOGRAPHY(EMG)

NERVE CONDUCTION STUDIES/ ELECTROMYOGRAPHY(EMG)

NERVE CONDUCTION STUDIES/ ELECTROMYOGRAPHY(EMG)

POSITRON EMISSION TOMOGRAPHY PET

MR SPECTROGRAPHY

non-invasive, ionizing radiation free analytical technique that has been used to study metabolic changes in brain tumors, strokes, seizure disorders, Alzheimer's disease, depression and other diseases affecting the brain.

MR TRACTOGRAPHY

Visual representation of neural tracts

NERVE AND MUSCLE BIOPSY

HORMONAL ASSAY