PMC3766327_01
Axial sections from a noncontrast enhanced computed tomographic images of the head (bone window). The complexity of the bilateral cranioplasties can be appreciated in these images. The left occipital Rickham reservoir is located medial to the burr hole cover and ridge from the left cranioplasty
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F1
This was likely secondary to the large thickness of his scalp and the location of his Rickham reservoir near a burr hole cover and along a raised ridge from his left cranioplasty site [Figure 1].
Ultrasound images of the (a) Rickham reservoir and (b) distal catheter tubing
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F2
Using a 6 cm, 13-6 MHz linear transducer, visualization in both the short-axis and long-axis views allowed for a thorough examination and confirmation of the exact placement of the Rickham reservoir [Figure 2].
(a) Patient's scalp with markings made in the short- and long-axis, localized with the emergency ultrasound system. (b) Successful cannulation of the reservoir with a 23-guage butterfly needle
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F3
The patient was then prepped in the standard fashion, with the Rickham site marked and outlined allowing for the easy placement of our 23-guage butterfly needle into the reservoir site [Figure 3].