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Looking Inside Your Head: Dr. Meyers and Dr. Lavine Examine Different Types of Imaging for Subdural Hematomas

Drs. Lavine and MeyersWhen neurosurgery first began, its practitioners had a problem: It was difficult to see inside a patient’s head. Today we have two ways to get a good look inside the skull: CT and MRI scans.

In a paper for Neurosurgery Clinics of North America called “Imaging of Subdural Hematomas,” Columbia neurosurgeon Dr. Sean Lavine and neurointerventionalist Dr. Philip Meyers* took a look at the history of brain imaging and which type of scan is best for observing bleeding inside the skull.

A subdural hematoma is an area where blood collects inside the skull, underneath the dura mater, a thin but tough membrane that covers the brain. Subdural hematomas are most often caused by head injuries. These hematomas can be treated, but to do so a neurosurgeon must be able to see inside the skull to find the location and size of the bleed.

Drs. Lavine and Meyers said in their paper that in the early stages of modern neurosurgery the only way to “see” inside a patient’s brain without opening it was to take an X-ray. This was not a perfect solution, however. X-rays are very good at showing dense objects like bones, but they tend to pass right through soft body tissue like the brain. This means the soft structures of the brain don’t show up well in an X-ray image, making it hard to tell a hematoma from the rest of the brain.

In the early 1900s neurosurgeons discovered that brain structures showed up better on X-rays when the brain was filled with air or helium. They drilled holes in the skull (ventriculography) or tapped into the spine (pneumoencephalography) to remove cerebrospinal fluid and fill the spaces in and around the brain with air. This got them a better view of any masses, but it was risky and uncomfortable for the patient.

Brain imaging remained problematic until the early 1970s, when the first computed tomography (CT) scan was performed. The first magnetic resonance imaging (MRI) scan followed a few years later. Both of these techniques give neurosurgeons a fantastic view of the brain, including any hematomas, in a completely noninvasive way.

In their study, Drs. Lavine and Meyers examined how often doctors use either CT or MRI to identify subdural hematomas and monitor the patient after surgery. They also examined the doctors’ reasoning behind which type of scan to use each time.

They found that most doctors tend to use CT scans, especially when it comes to monitoring patients after surgery, because CT scans are fast, widely available, relatively inexpensive and accurate at spotting complications.

However, physicians reported that MRI scans are better at picking up blood flow complications and postoperative infections. The study authors recommended that if the patient is at risk for one of those two problems, MRI should be considered.

Whether a neurosurgeon uses a CT scan or an MRI scan, we can all be thankful that neurosurgical imaging has come such a long way.

Learn more about Dr. Sean Lavine at his bio page here.
Learn more about Dr. Philip Meyers at his bio page here.

*Jason J. Carroll, M.D., Sean D. Lavine, M.D., Philip M. Meyers, M.D.

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