1. UNCG - Speech and Hearing Neurology KYNDALL ALLRED ALEXA DAVIS JULIE HURD KAYLA LOFLIN

2. Brain Diagnostic Testing: Overview Watch this video to learn the basics of Brain Diagnostic Testing:

3. What is Brain Diagnostic Testing? A vital tool that helps confirm or rule out the presence of a neurological disorder or other medical conditions Allows physicians to simultaneously see the structure of the brain & the changes in brain activity as they occur The most common are: MRI & CT Scans

4. Types of Neuro Diagnostic Tests: Angiography: a test used to detect blockages of the arteries or veins Biopsy: a test that involves the removal and examination of tissue from the body Picture of an Angiography

5. Types of Neuro Diagnostic Tests: Brain Scan: imaging techniques used to diagnose tumors, blood vessel malformations, or hemorrhage in the brain Cerebral Spinal Fluid Analysis: removal of a small amount of the fluid that protects the brain and spinal cord Computed Tomography (CT Scan): o noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues o yields a three-dimensional image of the brain o CT uses an x-ray beam that is passed through the brain

6. Types of Neuro Diagnostic Tests: Discography: suggested for patients who are considering llumar surgery, or whose lower back pain has not responded to conventional treatments Electroencephalography (EEG): o monitors brain activity through the skull o EEG is used to help diagnose certain seizure disorders, brain tumors, brain damage from head injuries, inflammation of the brain and/or spinal cord, and degenerative disorders that affects the brain

7. Types of Neuro Diagnostic Tests: Electromyography (EMG): used to diagnose nerve and muscle dysfunction and spinal cord disease Electronystagmography (ENG): describes a group of tests used to diagnose involuntary eye movement, dizziness, and balance disorders o also evaluates some brain functions Positron Emission Tomography (PET): visual technique where the subject is given radioactive form of glucose

8. Types of Neuro Diagnostic Tests: Functional MRI (fMRI): a form of magnetic resonance imaging of the brain that registers blood flow to functioning areas of the brain Regional Cerebral Blood Flow Magnetoencephalograph: a technique for mapping brain activity by recording magnetic fields produced by electrical currents occurring naturally in the brain, using very sensitive magnetometers.

9. Types of Neuro Diagnostic Tests: Single Photon Emission Tomography (SPECT): integrates two technologies to view your body: combination of a CT and a radioactive material (tracer) o the tracer is what allows doctors to see how blood flows to tissues and organs Fluoroscopy: type of x-ray with low dose of radiation o evaluates blood flow Polysonogram: a multiparametric test used in the study of sleep.

10. Types of Neuro Diagnostic Tests: Magnetic Resonance Imaging (MRI): uses computer-generated radio waves and a powerful magnetic field to produce detailed images of body structures including tissues, organs, bones, and nerves. o allows views of multiple slices of the brain o most widely used diagnostic imaging technique in neurology o very sensitive to abnormalities o generates cross-sectional image by using radio waves and a strong magnetic field to detect the distribution of water molecules in living tissue

11. Types of Neuro Diagnostic Tests: Thermography: uses an infrared thermometer to detect temperature changes in your skin, usually between two extremities Cranial Ultrasound: o Head Ultrasound: produces images of the brain and the cerebrospinal fluid  mostly used on infants and babies o Transcranial Doppler (TCD): evaluates both the direction and velocity of the blood flow in the major cerebral arteries of the brain.  Usually used during surgical procedures to monitor blood flow in the brain  Also can be used with MRI, MRA, and CT scans X-ray: usually done as a first examination with additional tests following

12. ADVANCES IN NEUROSURGERY WATCH THIS VIDEO TO LISTEN TO A BRIEF OVERVIEW OF IMPROVEMENTS AND ADVANCES IN NEUROSURGERY

13. Frameless Stereotaxy Mathematical discipline Calculates angles and distances from outside of the skull to a point within the brain Helps surgeons navigate safely through high risk areas of the skull and brain Allows neurosurgeons to know where he or she is in the brain at all times. Neurosurgeons can confidently undergo complex surgical approaches through the base of the skull. http://216.31.180.7/old%20files/pages/practiceframeless.ht ml

14. Telemedicine Internet link of surgery Princeton University can do video conferencing of microscopic surgeries and advise neurosurgeons of remote areas. Use of image guidance and optical cameras. Providing advanced neurosurgery to remote areas such as Tanzania, Africa

15. X-Knife Radiosurgery For brain lesions Vital technology for destroying intracranial metastatic tumors and benign tumors. Non coplanar arcs are used to target a lesion established by CT scans. Allow accurate destruction and avoids surrounding structures. No immediate side effects. READ: Northwestern Memorial Hospital, the only academic medical center in Chicago to offer Gamma Knife radiosurgery, has enhanced its radiosurgery program by upgrading to the most sophisticated equipment available for treating cancerous tumors and lesions.

16. Ultrasound Guided Ultrasound guided chiari malformation surgery Ultrasound guided Chiari malformation surgery - defects of cerebellum. Neurosurgeons are using ultrasound to guide the operation. It gives the surgeon the ability to monitor the patient’s condition in real time and decrease risks to the patient.

17. Spinal Cord Monitoring Surgeons choose to monitor the a MEP, EMG and nerve action portals during surgery. It allows the surgeon to remove bone fragments, tumors and substances while keeping track of the nerve conditions. The process immediately alerts the neurosurgeon to potential complications.

18. Balloon Technology

19. Balloon Technology (cont.) Illustration of the intra-aneurysmal balloon-assisted coiling technique. (a) Inflated Hyperform balloon at the entrance of the larger distal aneurysmal lobule, limiting coiling to the proximal lobule. (b) A Hyperglide balloon is inflated across the aneurysm neck as the deflated intra-aneurysmal balloon is slowly removed to prevent coil mass disturbance

20. Stereotactic Surgery Minimally invasive surgery Provides extreme accuracy There is a computerized link between a CT Scan or MRI to the equipment Neurosurgeons can precisely place a needle into a very small lesion or tumor with an accuracy of one millimeter

21. Open Microneurosurgery For brain aneurysms Also called “clipping” Patients under general anesthesia, an incision is made on the head and a window is made in the bone of the skull The surgeon then uses a microscope to place a platinum clip on the neck of the aneurysm, isolating it from the normal vessel The aneurysm is typically cured and the risk of subsequent re-bleeding is minimized In the case of an unruptured aneurysm, most patients are out of bed within a day or two of surgery

22. Endovascular Surgery for Brain Aneurysms Minimally-invasive, endovascular method of treating aneurysms In the endovascular technique, the patient is placed under general anesthesia and a catheter is inserted into an artery in the groin and brought up into the blood vessels of the brain. Images are then taken of the vessels of the brain to identify the aneurysm.

23. Hemicrainectomy In the News: GABRIELLE GIFFORD'S SURGERY o when a piece of the skull is removed to allow for brain swelling o the flap of bone that is removed was once a critical protective plate for the brain WATCH THIS VIDEO:

24. Hemicrainectomy (cont.) READ THIS ARTICLE:

25. THANK YOU We hope that this presentation has helped to increase your knowledge on Brain Diagnostic Testing and Advances in Neurosurgery!