Diagnostic Methods in Neurosurgery
Diagnostic Methods in Neurosurgery
Direct skull radiographs are the first diagnostic method, especially in patients with a head injury. The general shape of the cranium also provides information about bone fractures, bone erosion or bone hyperostosis, midline displacement, and signs of intracranial pressure.
Direct radiographs provide information about the normal anatomy and diseases of the spinal vertebral column. Pathologies such as fractures and slips can be detected by evaluating the neck, back, waist, and coccyx vertebrae and hip joints. The presence and degree of curvature in the back or waist can also be determined with scoliosis radiographs.
Computed Tomography (CT)
Computed Tomography can be used in the examination and diagnosis of all intracranial pathologies. If necessary, intravenous contrast material injection or water-soluble contrast material injection into the lumbar subarachnoid space can be used. With brain CT images, the state and size of the ventricular system, tissue density and changes in the parenchyma, the presence of shift in the midline structures, the width of the cortical sulci and Sylvian fissure, the presence of multiple lesions, changes in the skull base and calvarium are evaluated. With full spinal CT imaging, the extra spinal extension of the intraspinal lesion is visualized, lateral disc herniations are determined, and the dimensions of the bony canal and facet joints are determined.
Magnetic Resonance Imaging (MRI)
Detailed images of extra and intracranial structures are obtained with the MRI technique. Advantages of MRI technique over CT; Detecting pathologies such as non-ionizing radiation, absence of bone artifacts, early cerebral infarction, demyelinated plaques before CT imaging; It is the ability to make a section in the desired plan (sagittal, coronary, axial, oblique) without changing the patient's position. With the MR technique, the entire vertebral column, spinal canal, and spinal cord can be viewed clearly from different angles.
Lumbar Puncture (LP)
Measurement of CSF pressure by lumbar puncture, CSF sample for microscopic examination, diagnosis of subarachnoid hemorrhage, diagnosis of normal pressure hydrocephalus, and in the presence of CSF fistula, the CSF can be treated with pressure reduction by draining the CSF. LP should not be performed in the presence of suspicion of intracranial pressure.
It is the study of the spontaneous electrical activity of the brain through the scalp electrodes. In clinical practice, EEG is used in monitoring posttraumatic epilepsy and planning epilepsy surgery.
Electromyography / Nerve Conduction Study (EMG)
While the needle EMG records the electrical activity occurring in the muscle tissue, the nerve conduction study examines the course of the electrical stimulation in the peripheral nerve. These methods are basic methods for examining muscle and nerve diseases (myopathy, neuropathy). They are indispensable diagnostic methods in the diagnosis of peripheral nerve cuts, entrapment neuropathies, plexus lesions, spinal root lesions due to disc hernias and other causes, and intramedullary spinal cord pathologies in neurosurgery practice.
It is possible to determine the size and shape of the ventricle in the pediatric population in hydrocephalus by ultrasound through the anterior fontanel. It is also used in the diagnosis of orbital tumors and extracranial carotid artery diseases.
Intraoperative USG, on the other hand, allows intracranial or intraspinal pathologies to be monitored during surgery.
Serum levels of hypothalamic factors, anterior pituitary hormones, and target organ hormones are measured to determine the endocrine characteristics of the tumor in pituitary adenomas, other sellar and suprasellar tumors.
A biopsy is performed by open surgery or stereotactic method for definitive diagnosis and treatment planning in tumoral, infectious, viral, degenerative diseases of the central nervous system. A sural nerve biopsy may be required for a definitive diagnosis of neuropathies