Transcript Neurosurgical-Head-CTs

Interpretation of CT Brain- neuro
surgical prospective
DR A GAZDAR
04/09/2013
CT
 Sliced angled images of brain from skull base to
vertex.
 Either cross sectional (axial) / coronal / sagittal
images
 Radiocontrast used is iodinated : !!!allergy
Normal anatomy
 A. Frontal Lobe
 B. Frontal Bone
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(Superior Surface of
Orbital Part)
C. Dorsum Sellae
D. Basilar Artery
E. Temporal Lobe
F. Mastoid Air Cells
G. Cerebellar
Hemisphere
 A. Frontal Lobe
 B. Sylvian Fissure
 C. Temporal Lobe
 D. Suprasellar Cistern
 E. Midbrain
 F. Fourth Ventricle
 G. Cerebellar
Hemisphere
 A. Falx Cerebri
 B. Frontal Lobe
 C. Anterior Horn of
Lateral Ventricle
 D. Third Ventricle
 E. Quadrigeminal Plate
Cistern
 F. Cerebellum
 A. Anterior Horn of the
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Lateral Ventricle
B. Caudate Nucleus
C. Anterior Limb of the
Internal Capsule
D. Putamen and Globus
Pallidus
E. Posterior Limb of the
Internal Capsule
F. Third Ventricle
G. Quadrigeminal Plate
Cistern
H. Cerebellar Vermis
I. Occipital Lobe
 A. Genu of the Corpus
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Callosum
B. Anterior Horn of the
Lateral Ventricle
C. Internal Capsule
D. Thalamus
E. Pineal Gland
F. Choroid Plexus
G. Straight Sinus
 A. Falx Cerebri
 B. Frontal Lobe
 C. Body of the Lateral
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Ventricle
D. Splenium of the Corpus
Callosum
E. Parietal Lobe
F. Occipital Lobe
G. Superior Sagittal Sinus
 A. Falx Cerebri
 B. Sulcus
 C. Gyrus
 D. Superior Sagittal
Sinus
Trauma
 Both brain and bone windows
need to be examined
 Fractures are noted in sinuses,
skull base, mastoid bone,
temporal (petrous), skull.
 Either linear or depressed.
 Either displaced or undisplaced
SAH
 Most commonly
associated with vascular
anomalies
 Aneurysm, AVM
 CT grading is Fischer
grade
Acute SDH
 NSx emergency
 Crescent shaped
 Hyperdense, may contain
hypodense foci due to
serum, CSF or active
bleeding
 Does not cross dural
reflections
EDH
 Associated with skull
fractures
 Hyerdense biconvex
 Can cross the dural
borders
contusions
 ill-defined hypodense area
mixed with foci of hemorrhage.
 Adjacent subarachnoid
hemorrhage is common.
 >24-48 hours, hemorrhagic
transformation or coalescence
of petechial hemorrhages :
evolution
tumors
 Contrast needed to
delineate
 Multiple at grey white
junction– mets
 Dural based –
meningioma
 Diffuse intraparenchymal
– high grade gliomas
hydrocephalous
 Communicating or
obstructive
 Trapped horns
 Look for cause
 Associated hardware
Intracranial infections
 Abscess – extra or intra
cranial
 Extra : look for sinusitis,
thrombophlebitis, postop
 Intra: look for distant
source
Nerve wreck…..
 Describe the lesion…
 Fischer grade for SAH in image
 Please describe the pathology..
Thank you..
 Have a great day!!