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Daniel M. Sciubba, Michael J. Dorsi, Ryan Kretzer and Allan J. Belzberg

presence of potentially misleading artifacts. Case Report History and Examination This 15-year-old boy experienced transient paresthesias and weakness of the upper extremities immediately after a collision in a lacrosse game. He was placed in a rigid cervical orthosis and brought to a local emergency room. Computed tomography of the cervical spine suggested subluxation of C-5 on C-6, with perched facets on all images ( Fig. 1A–C ). The patient was transferred to our institution for surgical intervention. F ig . 1. Sagittal reconstruction CT images

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Sergio Brasil, Edson Bor-Seng-Shu, Marcelo de-Lima-Oliveira, Fabio Silvio Taccone, Gabriel Gattás, Douglas Mendes Nunes, Raphael A. Gomes de Oliveira, Bruno Martins Tomazini, Paulo Fernando Tierno, Rafael Akira Becker, Estevão Bassi, Luiz Marcelo Sá Malbouisson, Wellingson da Silva Paiva, Manoel Jacobsen Teixeira and Ricardo de Carvalho Nogueira

. The implementation of ancillary testing has become mandatory in many countries around the world, whether adopted in cases for which examination for BD is impossible or to help clarify conditions that might mimic compromised cortical or brain stem function. 5 , 24 , 44 Recently, the use of computed tomography angiography (CTA) has been extensively investigated as an ancillary method in the diagnosis of BD 2 , 3 , 15 , 16 , 23 , 33 , 42 and has been adopted by some medical societies, applying the standard proposed by Frampas et al. 16 regarding the lack of

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David R. Huyette, Benjamin J. Turnbow, Christian Kaufman, Dale F. Vaslow, Benjamin B. Whiting and Michael Y. Oh

Object

The standard method of ventriculostomy catheter placement is a freehand pass technique using surface anatomical landmarks. This study was undertaken to determine the accuracy of successful ventriculostomy procedures performed at a single institution's intensive care unit (ICU). The authors hypothesized that use of surface anatomical landmarks alone with successful results frequently do not correlate with desirable catheter tip placement.

Methods

Retrospective evaluation was performed on the head computed tomography (CT) scans of 97 patients who underwent 98 freehand pass ventriculostomy catheter placements in an ICU setting. Using the postprocedure CT scans of the patients, 3D measurements were made to calculate the accuracy of ventriculostomy catheter placement.

Results

The mean distance (± standard deviation [SD]) from the catheter tip to the Monro foramen was 16 ± 9.6 mm. The mean distance (± SD) from the catheter tip to the center of the bur hole was 87.4 ± 14.0 mm. Regarding accurate catheter tip placement, 56.1% of the catheter tips were in the ipsilateral lateral ventricle, 7.1% were in the contralateral lateral ventricle, 8.2% were in the third ventricle, 6.1% were within the interhemispheric fissure, and 22.4% were within extraventricular spaces.

Conclusions

The accuracy of freehand ventriculostomy catheterization at the authors' institution typically required 2 passes per successful placement, and, when successful, was 1.6 cm from the Monro foramen. More importantly, 22.4% of these catheter tips were in nonventricular spaces. Although many neurosurgeons believe that the current practice of ventriculostomy is good enough, the results of this study show that there is certainly much room for improvement.

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Felipe C. Albuquerque

. The crux of this debate is whether a subset of patients who are beyond the standard 6-hour time window for the performance of intraarterial thrombolytic techniques can be identified. Computed tomography perfusion offers the allure of delineating a penumbra of at-risk brain in this particular patient population. Without CT perfusion, these patients may be incorrectly labeled as unsalvageable or too risky to treat in an aggressive endovascular fashion. Nonetheless, this current review establishes the potential pitfalls associated with CT perfusion. These 7 sources of

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Silvia Gatscher, Stefan Brew, Tina Banks, Clare Simcock, Yvonne Sullivan and Joshua Crockett

arteriovenous shunt. 2 , 14 , 18 In particular, catheter angiography will always be required in slow flowing arteriovenous shunts and is at present the only study that provides detailed information on the arterial supply and venous drainage in those malformations. Computed tomography remains the initial imaging method of choice in acute presentations of intracranial vascular pathological entities because of its ready availability, ease of interpretation, speed, and convenience. 6 Multislice spiral CT angiography and venography share many of these advantages, and given

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George M. Ibrahim, Stefan Weidauer and R. Loch Macdonald

Infarction OccUrring after Subarachnoid hemorrhage), a randomized, double-blinded, placebo-controlled phase 2 dose-finding trial of clazosentan for prevention of angiographic vasospasm after aneurysmal SAH. 14 The methods and results have been published. 14 Eligible patients were 18–70 years of age with confirmed SAH. Two hundred eighty-nine (70%) were women, and the mean age was 51 ± 11 years. Computed Tomography Scanning Analysis All patients underwent CT scanning performed at baseline, which showed SAH. Patients then underwent catheter angiography, which

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Ahmad Khaldi, Vikram C. Prabhu, Douglas E. Anderson and Thomas C. Origitano

glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis . Neurosurgery 34 : 45 – 61 , 1994 2 Brenner DJ , Hall EJ : Computed tomography—an increasing source of radiation exposure . N Engl J Med 357 : 2277 – 2284 , 2007 3 Brown CV , Zada G , Salim A , Inaba K , Kasotakis G , Hadjizacharia P , : Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury . J Trauma 62 : 1339 – 1345 , 2007 4 Einstein AJ , Henzlova MJ , Rajagopalan S

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Yao Li, Zhonghai Shen, Xiangyang Wang, Yongli Wang, Hongming Xu, Feng Zhou, Shaoyu Zhu and Huazi Xu

scoliosis: a computed tomography analysis of screw placement relative to the aorta and the spinal canal . Spine (Phila Pa 1976) 30 : 2078 – 2083 , 2005 2 Dwyer AF : Experience of anterior correction of scoliosis . Clin Orthop Relat Res 93 191 – 206 , 1973 3 Ebraheim NA , Xu R , Ahmad M , Yeasting RA : Anatomic considerations of anterior instrumentation of the thoracic spine . Am J Orthop 26 : 419 – 424 , 1997 4 Ebraheim NA , Xu R , Urbancic R , Yeasting RA : Anatomic considerations for anterior instrumentation of the lumbar

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Shobhan Vachhrajani, Anish N. Sen, Krishna Satyan, Abhaya V. Kulkarni, Sherri B. Birchansky and Andrew Jea

establishing truly valid, reliable normal estimates for these measurements in children. The value of such population-specific parameters cannot be understated. Methods Patient Group During a 2-month study period, 42 consecutive patients (25 boys and 17 girls; mean age 100.9 months, range 1–214 months) who had undergone CT scanning of the cervical spine with coronal and sagittal reconstructions at Texas Children's Hospital were reviewed. Computed tomography scans were read by a group of independent fellowship-trained pediatric neuroradiologists. Only those patients

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Mahesh Karandikar, Sohail K. Mirza, Kit Song, Tong Yang, Walter F. Krengel II, Kevin F. Spratt and Anthony M. Avellino

, Tippets R , Walker M , Carey L : Pediatric cervical spine instrumentation using screw fixation . Pediatr Neurosurg 22 : 147 – 157 , 1995 3 Brockmeyer DL , York JE , Apfelbaum RI : Anatomical suitability of C1-2 transarticular screw placement in pediatric patients . J Neurosurg 92 : 1 Suppl 7 – 11 , 2000 4 Brody AS , Frush DP , Huda W , Brent RL : Radiation risk to children from computed tomography . Pediatrics 120 : 677 – 682 , 2007 5 Browd SR , McIntyre JS , Brockmeyer DL : Failed age-dependent maturation of the