Radiological Examinations

on Neurosurgery
Andre G Gadzali

 Doctor: What am I supposed to do? I dont know how to read

his radiograph in this case of emergency surgery.
Assistant: Oh, (S)ugar-(H)oney-(I)ce-(T)ea?$@#*!!!!
Scrubbing nurse: I better leave. Gosh Im working with an
idiot.

Radiological Examination in
Neurosurgery
Basic: white, black, coloured.
Type:
1. X-Ray (opaque or lucent).
2. Myelography (opaque or lucent).
3. X-Ray Angiography (opaque or lucent).
4. CT Scan (Iso-, Hyper-, or Hypodense).
5. Hellical 3D CT (Iso-, Hyper-, Hypodense, or Coloured).
6. MRI (Iso-, Hyper-, or Hypointense).
7. MR Angiography (Iso-, Hyper-, Hypointense, or
Coloured).
8. Functional MRI.
9. MR Spectrophotometry.

Basic Principles
Note the picture type and its
position.
Note patients identifications.
Note date and time when it made.
Note the picture quality.
Note the simmetry of the picture.
After that, start to note the
abnormality one by one, layer by
layer.

Common Neuroradiography
Positions
Skull X-Ray (AP-Lat, Townes, Open Mouth,
Submentovertex).
Cervical/Thorax/Thoracolumbar/Lumbosacr
al X-Ray (AP-Lat or Dynamic).
CT Scan/Hellical 3D/Angiography (axial OM
Line or special localizing according to its
target).
MRI/MRA (OM Line or special localizing
according to its target which shown as
axial, coronal, or sagittal plane).

Skull X-Ray
Describe the basic principles first.
Describe the abnormality/ies on
cranial vault and sutures (fracture
lines and its type [linear, stellate,
diastasis, double contour shape],
osteolytic/genetic process, or
avulsion).
Describe any abnormality/ies on
facial bone structures respectively.

Cervical X-Ray
All the seventh bone levels should be
shown clearly.
Describe the basic principles first.
Describe the abnormality/ies appearance
on each level might be seen (fracture lines
and its shape [linear, burst, compression,
tear drops], osteolytic/genetic process).
Describe any abnormality/ies on soft
tissue structures width respectively.

CT Scan (1)
Describe the basic principles first,
position of (L)eft and (R)ight, and
scanogram.
Describe the midline (note the shift).
Describe the brain convolutions (note
the sulci, gyri, and cisterns; describe
the appearance: compresion or blur).
Describe the ventricle system width
(note the dilatation).

CT Scan (2)
Describe the abnormality/ies which lies on
brain convolutions, intraparenchymal, or
intrventricular (note the appearance of mass,
shape, and its colour: biconvex, crescentic,
salt & pepper appearance, solid/cystic,
regularity, different density shade,
enhancement, pneumocephalus).
Describe the bone (appearance of
discontinuity, lytic/genetic process)
Describe the soft tissue (appearance of
swelling).

Expertise/Results
Describe all the appearance that shown on XRay and/or CT Scan picture, then
Write down the diagnosis according to the
patient clinical state (GCS or type of spinal
injury), the appearance of fracture/s regarding
to its location and wound (open/close), and
abnormality/ies of brain or spine.
Example: Moderate HI+Close linear # at (L)
temporoparietal+Cerebral contusion at (R)
frontal+SAH.

Conclusions
Nothing hard to start, make it simple as
you can.
Dont feel youre a fool just because of
different interpretation(s) among other
clinician(s), its just only a matter of time.
Keep trying, be patient, never bored.
Never trust any source who give you a
simple knowledge/notes/translated book(s),
just only trust recent/revised original
TEXTBOOK(S).