An intraoperative clinical photograph showing a neurosurgical procedure (craniotomy) for the management of an extensive subdural empyema. The image displays a wide surgical field with the dura mater retracted, revealing a thick, viscous, yellowish-white purulent collection that covers the majority of the visible cerebral hemisphere. The underlying and adjacent brain parenchyma exhibits significant congestion and hyperemia, characterized by a deep reddish hue and prominent vascularity, indicative of severe inflammatory response. Surgical instruments, including retractors and a suction tip, are visible at the margins of the craniotomy. This visual demonstrates the clinical manifestation of a large-scale intracranial infection and the necessity of surgical drainage to alleviate mass effect and control the infectious process within the subdural space.

Clinical photograph of an intraoperative brain biopsy procedure. The image shows a prepared surgical field on the scalp, demarcated by sterile blue drapes and a clear adhesive incise drape. A circular craniotomy site is visible, with the scalp edges retracted using green Raney clips and sutures held by several hemostats/clamps. Within the surgical opening, the underlying cerebral tissue is exposed, revealing a prominent, deeply pigmented (blackish-brown) lesion localized to a gyrus, which is suspicious for metastatic melanoma. Moderate bleeding is observed around the incision margins, with blood tracking over the yellow-prepped scalp and onto the surrounding drapes. Surgical adjuncts visible include a clear suction tube, a saturated gauze sponge, and various cables for monitoring or cautery. This image demonstrates the visual presentation of a pigmented intracranial metastasis during neurosurgical intervention.

This clinical photograph captures a per-operative view of an open craniotomy during a neurosurgical procedure. The focal point of the image is the exposed brain surface, specifically the cerebral cortex, displaying characteristic gyri and sulci covered by the arachnoid mater. The surgical field is bounded by retracted scalp tissue and white surgical sponges or gauze used for hemostasis and to maintain field clarity. Significant sanguineous fluid (blood) is visible around the margins of the cranial opening. To the right of the primary cortical exposure, a linear suture line is visible on the reflected dural or scalp flap, indicating a phase of tissue approximation or closure. This image serves as an educational example of a large craniotomy, typical in procedures such as the Arana-Iniguez technique for the surgical management of intracranial lesions like hydatid cysts.

This composite of three axial computed tomography (CT) images illustrates post-treatment clinical findings in a patient with multi-organ pathology. Figure A is a non-contrast brain CT scan showing a right occipital craniotomy site. The surgical cavity is identifiable, surrounded by irregular linear hyperdensities (suggestive of acute post-operative hemorrhage) and areas of low-attenuation consistent with diffuse vasogenic edema over the parietal convexity. Figures B and C are CT angiography (CTA) images of the chest in lung and mediastinal windows, respectively. Yellow arrows indicate subsegmental filling defects within the right upper lobe pulmonary vasculature, diagnostic of small-volume pulmonary emboli (PE). The lung parenchyma adjacent to the emboli shows mild irregularities without dense consolidation. These images highlight the clinical challenge of managing systemic thromboembolic disease in the immediate post-operative period following neurosurgery, where the risk of intracranial hemorrhage complicates anticoagulation therapy. The educational focus is on identifying post-surgical intracranial complications and vascular filling defects on CTA.

This axial non-contrast CT scan of the brain demonstrates a post-operative state following neurosurgical intervention in the bilateral frontal region. Key features include a bilateral frontal calvarial defect (craniotomy site) with overlying extracranial soft tissue swelling and a visible surgical drain tube. Intracranial findings are highlighted by a red circle, revealing a large, mixed-density intraparenchymal hematoma located in the interhemispheric and parafalcine regions, predominantly affecting the left frontal lobe. A hyperdense metallic focus, consistent with an aneurysm clip, is visible within the anterior interhemispheric region, associated with mild streak artifacts. There is evidence of mass effect, indicated by the effacement of the frontal horn of the left lateral ventricle. Small air-density foci (pneumocephalus) are scattered within the frontal region and adjacent to a thin, mixed-density subdural collection. The imaging illustrates typical post-surgical complications and the management of a ruptured intracranial aneurysm.

This diagnostic image is an axial non-contrast computed tomography (CT) scan of the brain, specifically a post-operative follow-up following evacuation of a left-sided intracranial hemorrhage. The image shows the brain at the level of the lateral ventricles. There is evidence of a left-sided craniotomy. In the left frontoparietal region and basal ganglia, there is a large area of hypoattenuation (low density), which represents encephalomalacia and evolving liquefactive necrosis in the site of the previous hematoma. The mass effect and midline shift observed in the acute phase have largely resolved, with the midline structures, including the septum pellucidum, returning to a near-normal position. The lateral ventricles appear symmetrical without evidence of acute intraventricular hemorrhage or hydrocephalus. No acute hyperdense areas suggestive of rebleeding are identified. This scan illustrates the expected radiological progression during the subacute phase of recovery following surgical hematoma evacuation in a patient with a history of COVID-19-associated neurological complications.