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Michael Gofeld, Sandee J. Bristow, Sheila Chiu, and Michel Kliot

abnormalities. Recent technological advances in ultrasonography have improved resolution to the point where peripheral nerves as small as 2 mm in diameter can be visualized, and their relationship to important adjacent structures, such as blood vessels and bony landmarks, can be appreciated. 8 In addition, and in contrast to MRI, ultrasonography can be routinely used in the surgical theater. Therefore, the application of ultrasound in the surgical environment, intraoperative ultrasonography, could therefore be of great benefit in guiding the surgeon to the targeted nerve

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Marc A. Flitter, William A. Buchheit, Frederick Murtagh, and Marc S. Lapayowker

T his is a preliminary report on the utilization of Doppler flow detection to determine cerebrospinal fluid (CSF) shunt patency. The technique has been particularly useful in the management of patients whose clinical picture suggests shunt malfunction despite an apparently patent shunt as determined by manipulation of the flushing device of the system. Doppler flow detection depends on the changes in the frequency of sound waves reflected from moving acoustical interfaces. In the Doppler device the ultrasound waves are produced by electrical stimulation of a

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Zvi Ram, Thomas H. Shawker, Mary H. Bradford, John L. Doppman, and Edward H. Oldfield

P ituitary microadenomas often are not visualized on preoperative magnetic resonance (MR) imaging 1, 2, 6, 9 and may be difficult to find during surgical exploration of the pituitary, particularly in a patient with Cushing's disease. Although ultrasound is routinely used during surgery to localize islet-cell and parathyroid tumors, 5, 7 the use of ultrasound to localize and define pituitary tumors has never been evaluated. To enhance intraoperative localization of pituitary adenomas, we assessed the feasibility of using ultrasound to detect and localize

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Richard C. Nagle, Michael S. Taekman, Ronald F. Shallat, and Ronald A. Cohen

. Apgar scores were 1 and 6 at 1 and 5 minutes, respectively. Ultrasound examination of the head 4 days after birth revealed a left germinal matrix hemorrhage with bilateral intraventricular blood and mild to moderate ventricular enlargement. The hospital course was complicated by severe respiratory distress syndrome, pulmonary interstitial emphysema, pneumothorax, and a patent ductus arteriosus, which was occluded by indo-methacin administration. Feeding intolerance necessitated central hyperalimentation. At 2 months of age the child remained on a respirator because of

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Mitchel S. Berger

the use of stereotaxic devices. Ultrasound guidance would be an acceptable alternative, but the size of the probe head (transducer) has necessitated performance of a craniotomy or small craniectomy. The author has designed an apparatus for use with currently available burr holesized ultrasound probes that permits stereotaxic biopsy through a burr hole in an awake patient. Only one CT scan is required, and the entire procedure can be performed more quickly than a CT-guided biopsy. This report describes the apparatus and presents the results and limitations of its

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Nicola Di Lorenzo, Vincenzo Esposito, Pierpaolo Lunardi, Roberto Delfini, Aldo Fortuna, and Giampaolo Cantore

indicated or will be dictated by the pathology of the lesion. However, CT-guided stereotactic biopsy is time-consuming and costly. 9, 18, 20 As the procedure takes place partly in the CT suite, the scanner is temporarily unavailable for other studies. In addition, any changes in localization that might arise during the procedure, such as after aspiration of a cyst, may require a repeat CT scan to recalculate the stereotactic coordinates. To overcome these disadvantages, the search for an alternative technique has recently focused on ultrasound-guided brain biopsy. 3, 5

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Jan Regelsberger, Günter Delling, Michael Tsokos, Knuth Helmke, Gertrude Kammler, Heidi Kränzlein, and Manfred Westphal

than 13% of the patients in our cohort. Alternative diagnostic methods that are sensitive enough to identify cases of NSP but do not involve ionizing radiation or require sedation would be welcomed by physicians caring for these young patients. On the basis of many years’ experience using intraoperative ultrasound in neurosurgery, we have established an ultrasound protocol for analyzing the anatomy of normal and pathological sutures in infants with craniofacial abnormalities. In this study, we report on 100 cases in which NSP was investigated by means of near

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Francis J. Fry, Stephen A. Goss, and James T. Patrick

T he ability to modify brain tissue permanently or transiently at preselected localized sites is an important area of interest to neuroscientists, neurologists, and neurosurgeons. Focused ultrasound has been used in experimental animal brain research for focal modifications of brain tissue, 1, 3, 8, 10, 12 as well as in preliminary studies of the application of ultrasonic techniques for tissue modification in human stereotaxic neurosurgery. 11, 16, 17 Particularly for human therapy, the technique was seriously compromised by the necessity for removal of the

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Nathaniel K. Coulson, Peter A. Chiarelli, David K. Su, Jason J. Chang, Brian MacConaghy, Revathi Murthy, Peter Toms, Terrence L. Robb, Richard G. Ellenbogen, Samuel R. Browd, and Pierre D. Mourad

. Finally, ultrasound image guidance requires a craniotomy for its use, a large hole relative to that needed for catheter insertion, with attendant additional time, and training in the use of diagnostic ultrasound machine, as well as the machine’s presence during the procedure. Given the existing options, an ideal technology for catheter guidance would 1) be portable, for use in a range of settings, 2) allow dynamic choice of trajectory, 3) facilitate rapid setup, and 4) provide guidance based on real-time features of the immediately existing ventricular architecture

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William E. Whitehead, Andrew Jea, Shobhan Vachhrajani, Abhaya V. Kulkarni, and James M. Drake

M inimizing shunt-related morbidity and prolonging shunt survival continue to be important goals for the pediatric neurosurgeon. Despite the relative safety of ventricular cannulation based on surface anatomy, multiple passes and errant catheters are not infrequent, especially in cases of normal-sized or slitlike CSF spaces. A pericallosal artery pseudoaneurysm secondary to errant cannulation of the frontal horn during endoscopy-assisted ventricular catheter placement was recently described in a case report. 8 Intraoperative ultrasound allows real