Diagnostic Procedures of Neurosurgery

Neurodiagnostic Approaches

Direct Roentgenogram
Direct head graphs are the first diagnostic method, especially in patients with head trauma. The general form of cranium also informs about bone fractures, bone erosion or bone hyperospermia, midline shift and Increased Intracranial Pressure Symptoms findings.

Direct graphs provide information about the disease with the normal anatomy of the spinal vertebral column. Pathologies such as fractures, cracks, and slips can be detected by assessing the joints of the neck, back, waist and tail joints and hip joints. Scoliosis graphs can also be used to determine the presence or degree of curvature of the back or the ground.

Computerized Tomography (CT)

Computerized tomography can be used to examine and identify all intracranial pathologies. Intravenous contrast medium injection or water-soluble contrast medium injection at the lumbar subarachnoid site can be used if necessary. The following changes are assessed with brain CT images; state and size of the ventricular system, tissue density and changes in the parenchyma, shift in midline structures, cortical sulcus and Sylvian fissure width, whether multiple lesions are present, the changes in head scab and calvarium. With all spinal CT imaging, imaging of the extra spinal extension of the intra-spinal lesion, determination of the lateral disc herniation, determination of the dimensions of the bone canal and facet joints are observed in detail.  

Magnetic Resonance Imaging (MRI)
Detailed images of extra and intracranial structures are obtained with MRI technique. MRI superiority against CT; The use of ionizing radiation, the absence of bone artefacts, early cerebral infarcts, demyelinating plaques can be detected before imaging in CT and conducting cross section without changing the position of the patient (Sagittal, coronary, axial, oblique). With the MR technique, the entire vertebral column, spinal canal, and spinal cord can be clearly visualized at various angles. Predominates CT in examination of the spinal pathologies.

Lumbar Puncture (LP)
Lobar pneumonia CSF measurement, microscopic examination of CSF sample, diagnosis of subarachnoid hemorrhage, diagnosis of normal pressure hydrocephalus and in the presence of a CSF fistula it is possible to treat the CSF by directing pressure to the CSF. LP should not be conducted in presence of Increased Intracranial Pressure Symptoms.

Electroencephalography (EEG)
It is the examination of the spontaneous electrical activity of the brain via the scalp electrodes. EEG is used in the planning of epilepsy surgeon in the follow-up of posttraumatic epilepsy in clinical practice.

Electromyography / Nerve Conduction Study (ENCS)
The needle records the electrical activity occurring in the EMG muscle tissue while the neural conduction study examines the peripheral nerve of the electrical stimulus. These methods are the basic methods for examining muscular and nerve diseases (myopathy, neuropathy). In brain and neurosurgery practice, peripheral nerve incisions, trap neuropathies, plexus lesions, disc hernia and spinal root lesions due to other causes, intramedullary spinal cord pathologies are indispensable diagnostic methods.

Ultrasonography (USG)
Hydrocephalus can be detected in the pediatric population by prefrontal ultrasonography to determine the size and shape of the ventricle. It is also used to diagnose orbital tumors and extra cranial carotid artery diseases.
Intraoperative USG allows intracranial or intraspinal pathologies to be monitored during surgery.

Neuroendocrine Studies
In order to determine endocrine features of pituitary adenomas, other sellar and suprasellar tumors, hypothalamic factors, frontal pituitary hormones and the serum levels of target organ hormones are measured.

Biopsy is performed by open surgery or stereotactic method for definitive diagnosis and to plan treatment in tumoral, infectious, viral, degenerative diseases of central nervous system. Sural nerve biopsy may be necessary to get a definite diagnosis in Neuropathies. 

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