bluuebunny/crossref_metadata_2025 huggingface dataset:
Substrati anatomo-patologici degli aneurismi cerebrali
Authors: Angelini A. , Abdurahakman A. , Manara R. , Amistà P. , Thiene G.
Published: April 2015

Atherosclerosis and fibromuscular dysplasia are the two most common causes of cerebral aneurysms. Saccular aneurysms are mainly congential and located in the bifurcations. Fusiform aneurysms are caused by atherosclerosis and involve the posterior portion, mainly the vertebral and basilar arteries and may develop into giant aneurysms. Cerebral atherosclerosis causes two types of lesions: stenosis with the formation of atheromatous plaque jutting into the lumen, and aneurysms leading to vascular remodelling with erosion of the internal elastic membrane, atrophy of the media and thickening and hyalinization of the intima.

Atheromatous plaque is characterised by a fibromuscular intimal cap and a necrotic lipid core with atrophy of the underlying media. Plaque may thicken to occlude the vessel by intraplaque haemorrhage and superimposed occlusive thrombosis due to ulceration, or rupture of the fibrous cap caused by inflammation. It remains unsettled whether atherosclerotic cerebral aneurysms are malformations, with congenital abnormalities of the internal elastic membrane and elastic fibres constituting the media, or whether atheromatous changes are secondary to impaired blood flow.

Thinning of the wall could also be caused by flow changes with parietal stress resulting from the turbulence caused by atherosclerotic stenotic lesions or the outcome of dissection of the arterial wall. Fibromuscular dysplasia is a multifocal vascular disease of unknown origin, not atherosclerotic or inflammatory, mainly affecting the brain media with lesions characterized by areas of concentric fibromuscular tissue jutting into the vessel lumen alternating with areas of thinning to almost disappearance of the tunica media and discontinuity of the internal elastic membrane in areas of thinning with the formation of aneurysms.

Vessel calibre varies with areas of luminal stenosis alternating with areas of aneurysmal dilatation. The origin of this disease remains unknown and it is thought to be multifactorial possibly associated with saccular aneurysms, fusiform giant aneurysms, dissection of the intracranial arteries, cavernous fistulae and stenosis or occlusion associated with dysplasia. Aneurysms in the brain may share the same underlying mechanisms as aneurysms elsewhere involving atherosclerosis and fibromuscular dyspasia, i.e. remodelling of the extracellular matrix. A recent hypothesis suggested that cerebral aneurysms were caused by an active mechanisms in the arterial wall rather than a passive process linked to genetically determined structural defects or purely haemodynamic events. Apoptosis has also been implicated in the remodelling of the extracelular matrix in the wall of cerebral aneurysms.
Terapia chirurgica degli aneurismi cerebrali
Authors: Scienza R. , Pavesi G.
Published: April 2015

Cerebrovascular disease continues to be a major source of morbidity and mortality in our aging population. Cerebrovascular disease continues to present challenges in the diagnostic and therapeutic arena. Prevention and treatment of stroke represent an unconquered frontier in clinical neuroscience. The ability to identify and treat cerebrovascular abnormalities before permanent ischemic deficit occurs is rapidly increasing. Endovascular therapy of vascular malformations and vasospasm are today a necessary comparison with microsurgery; cerebral blood flow measurements tool give clinicians the opportunity to identify patients at risk for ischemic damage and to suggest new therapeutic paths; minimally invasive diagnostic tools are gradually reducing the indication for cerebral angiography.

Such major advances in technology, that are actually changing our therapeutic approach to cerebrovascular disease, and to cerebral aneurysms treatment, will soon result in safer more effective treatments, minimizing the onset of permanent neurologic deficits. Anyway, it is a fact that the majority of cerebral aneurysms are still treated by microsurgery, either because of the wider diffusion of specialized centers offering this technique, or because of the longer follow up on the obtained results achieved by neurosurgeons. The object of the present study is to show how the surgical treatment of cerebral aneurysms is organized, and which are the main problems that neurosurgeons are facing in the effort to conjugate microsurgical treatment with the new ancillary technologies for the study of cerebrovascular malformations.
Aneurismi intracranici problematici Chirurgia e terapia endovascolare a confronto
Authors: Skrap M. , Vindigni M. , Janes P.P. , Petralia B.
Published: April 2015

The surgical technique used for cerebral aneurysms is still considered a delicate procedure but surgeons' skill yields excellent results in the majority of regular aneurysms. Moreover, the endovascular treatment with detachable coils has become a routine procedure and at present the discussion about the best indication for treating the aneurysms is lively. We present our series of 361 aneurysms treated in six years with 267 surgical procedures and 94 endovascular treatments. The indication for endovascular treatment in our Department is usually put for aneurysms of the basilar trunk, basilar bifurcation, infraclionid tract of the Internal Carotid artery, in patients with higher H&H grade (3–4) and in older patients with poor general condition. The global mortality of endovascular cases was 21% while in the surgical series the global mortality was 15%. We must consider that 60% of endovascular cases were in grade 3–4 of Hunt&Hess while in the surgical series only 40% were in the same situation. Only 2.7% of the cases (10 patients) were a really difficult problem for each separate technique. In these cases a combination of surgical and endovascular procedure was adopted and in only five cases was it possible to treat the aneurysms properly.

In our opinion, a combined approach can be useful only in some selected cases but we should take into account the fact that nowadays surgery has reached the upper limits of its technique while, on the contrary, the endovascular technology is still in progress.
Il trattamento endovascolare degli aneurismi giganti
Authors: Sirabella G. , Saponiero R. , Esposito F. , Napoli A.N. , Siani A. , Locatelli G.P.
Published: April 2015

We describe giant aneurysms (> 25 mm in diameter) discussing endovascular techniques and reporting the outcome of treated cases.

The endovascular technique to be adopted must be chosen after careful morphologic analysis of the aneurysm. Currently, the best solution is probably occlusion of the parent vessel thereby eliminating the mass effect and excluding the aneurysm from flow.
Diffusion-Weighted and Diffusion Tensor Magnetic Resonance Brain Imaging: Principles and Applications
Authors: Pizzini F. , Beltramello A. , Piovan E. , Alessandrini F.
Published: April 2015

Diffusion Weighted Imaging (DWI) is one of the most recent products of Magnetic Resonance (MR) technology evolution. DWI has been proposed as a noninvasive tool for evaluating structural and physiologic states in biologic tissues as hyperacute ischemic changes within brain tissue. Recently, its more complex and detailed evolution, Diffusion Tensor Imaging (DTI), has been introduced and its clinical applications are the evaluation of anatomical structures and pathologic processes in white matter. White matter quantitative maps that indicate the integrity of brain tissue, color map, and tractography that identifies macroscopic three-dimensional architecture of fiber tracts (e.g., projections and association pathways) can be obtained with DTI.

Diffusion weighted imaging visualization techniques (ADC and Trace) are applied for the study of stroke, in the differential diagnosis of expansive lesions (e.g. epidermoid vs. arachnoid cyst) and in detecting traumatic and other lesions associated with restricted diffusion (e.g. MS plaques). On the other hand, DTI provides the identification of abnormalities in the otherwise normal appearing white matter with the understanding of the organization of the fibers, both in tumors and in other cortical or white matter diseases (including stroke, dementias, demyelinating-dismyelinating diseases, epilepsy, schizophrenia). Furthermore, in combination with functional MR, DTI might contribute to the comprehension of brain development, aging and connectivity, thus having a significant impact on brain functional studies.
Neuroradiology of Pediatric Hemolymphoproliferative Disease
Authors: Rossi A. , Biancheri R. , Lanino E. , Faraci M. , Haupt R. , Micalizzi C. , Tortori-Donati P.
Published: April 2015

Hemolymphoproliferative diseases (HLD) are among the most common causes of morbidity and mortality in children. In the past few years, the increased effectiveness of treatment modalities has significantly increased overall survival, but has also disclosed new aspects of the natural history of these disorders, among which central nervous system (CNS) involvement. CNS complications of HLD can basically be categorized into direct localization of primary disease, indirect effects of malignancy such as cerebrovascular or infectious complications, and iatrogenic side effects. Magnetic resonance imaging plays an important, often crucial role in the diagnosis of several of these disorders. Close interdisciplinary collaboration between hemato-oncologists and neuroradiologists is of paramount importance to provide affected children with an early diagnosis and proper treatment.
Diffusion-Weighted MR Imaging in the Evaluation of Normal Appearing White Matter in Patients with Tuberous Sclerosis
Authors: Garaci F.G. , Floris R. , Manenti G. , Fantozzi L.M. , Bozzao A.
Published: April 2015

The aim of the present study was to assess the presence of changes in diffusivity in the brains of patients with tuberous sclerosis (TS) in areas free from signal alterations on conventional MR sequences. Ten patients and controls were evaluated. ROI were placed on ADC maps in the white matter (frontal, parietal and centrum semiovale) excluding areas with signal alterations on FLAIR images. ADC values of supratentorial white matter turned out to be higher than controls (P < .0001). Our data indicate that TS is more widely diffused than expected in the brains of affected patients.
Embriologia e genetica dello sviluppo cerebellare
Authors: Gallucci M. , Iannessi F. , Puglielli E. , Splendiani A. , Russo R.
Published: April 2015

During the fourth week of development, the mesencephalic flexure and cervical flexure appear in the cranial region of the neural tube, delimiting three neural vescicles: the prosencephalon, mesencephalon and rhomboencephalon. During the fifth week, the pontine flexure forms in the roof of the rhomboencephalon, marking the division between the metencephalon and myeloencephalon, the future medulla oblongata. The dorsal part of the metencephalon (alar plate), between the mesencaphalic isthmus and the pontine flexure, will give rise to the cerebellum, whereas its ventral part (basal plate) will give rise to the pons. The alar plates, lateral to the deepening pontine fissure and the hindbrain cavity, present an intense proliferative activity with the formation of two extensions which fuse just behind the isthmus to form the cerebellar plate. During the sixth week of development, the rhombic lips appear in the posterolateral regions of this strip and after persistent proliferative activity they fuse along the median line. Median thickening of this region will give rise to the vermis, while the two lateral masses become the lateral lobes. During the seventh week, the flocculonodular lobe will form. Between the eighth and ninth weeks, the vermis expands caudally with progressive dilatation of the fourth ventricle whose Luschka and Magendie foramina are still unperforated. The cerebellar proliferation and differentiation processes are correlated to the activity of two separate germinal areas: the ependymal ventricle and the rhombic lip. From the eighth week, neuroblastic migration starts from the rhombic lip which in successive genetically controlled steps leads to the formation of the external granular layer of the cerebellar cortex. From the ventriculo-ependymal zone cells migrate to form the cerebellar nuclei destined to differentiate into Purkinje cells. The cerebellar recess starts to develop around the twelfth week with the formation of the primary fissure separating the anterior and posterior parts of the cerebellum to end with the complete formation of all cerebellar lobes at around the twenty-fourth week of development. The foliation process starts when the recess has formed and continues in the first months of life after birth. The processes of cell development and differentiation are genetically programmed and the outcome of an interaction between genetic and environmental factors. The different stages of embryonic development are thought to be controlled by sequential ordered activation of genetic clusters (homeotypic genes) which in turn encode for a series of molecules directly involved in the regulation of cell and tissue interactions. There is increasing evidence of genetic involvement in the different types of cerebellar malformation whose expression and association with other extracerebellar malformations depends on the developmental age at which the genetic change occurred.
Ruolo della Neuroradiologia nella diagnostica della malformazione di Chiari di I tipo
Authors: Bozzao A. , Bonamini M. , Fantozzi L.M.
Published: April 2015

Chiari's type I malformation is defined as the caudal displacement of the cerebellar tonsils into the occipital foramen, sometimes associated with displacement of the cerebellar vermis. Syringomyelia is present in 65% of patients with Chiari's type I malformation and in 25% of all cases of tonsillar ectopia detected by MR scan. In contrast, asymptomatic syringomyelia is sporadic. MR investigation of the whole spinal cord is indicated when Chiari's type I malformation is present. Although the incidence of symptomatic patients increases when the ectopia exceeds 5 mm, there are no statistically significant correlations between the size of cerebellar ectopia and the incidence of syringomyelia or the degree of other clinical manifestations such as headache, Ménière's syndrome and inferior cranial nerve impairment. Symptoms and hence prognosis and possible surgical treatment depend not only on the tonsillar displacement, but on its impact on CSF dynamics. Cine-MR scanning offers great potential in the assessment of CSF dynamics in the occipital foramen, revealing asymptomatic subjects at risk of developing syringomyelia. The surgical treatment of this category of patients remains a controversial topic.
Sinovenous Thrombosis in Newborn
Authors: Ferrari E. , Doni D. , De Grandi C. , Paterlini G. , Viganò E. , Tagliabue P.
Published: April 2015

We present a case of cerebral thrombosis in a newborn with no apparent risk factors but who further investigations proved to have Protein C deficiency. Symptoms of presentation were seizures; the diagnosis was made by Magnetic Resonance Imaging (MRI) and angioMRI; a thrombolytic therapy with recombinant tissue plasminogen activator (rTPA) followed by a prophylaxis with low molecular weight heparin (LMWH) were successfully implemented.

Given the advances in imaging techniques (Power Doppler examination via the mastoid approach), cerebral ultrasound allowed us to suspect thrombosis, to monitor treatment efficacy and to confirm complete resolution, in this case.
Considerazioni sulla patologia traumatica dorsale in età pediatrica
Authors: Splendiani A. , De Amicis R. , Pupillo V. , Puglielli E. , Masciocchi C. , Gallucci M.
Published: April 2015

Trauma remains one of the major causes of death in children and adolescents. The mechanisms underlying response to traumatic injury differ radically in adults and children for anatomical and biomechanical reasons. This study is a retrospective review of all patients admitted to our hospital with suspect spinal trauma from 1999 to date, analysing in children the incidence, type of bone injury, possible spinal cord involvement and clinical condition on discharge. Of 143 cases of spinal trauma examined at our hospital over a four-year period by x-ray, computed tomography and magnetic resonance imaging, 21 were aged between six and 16 years. In agreement with literature reports, the incidence was lower than that in adults, but carried a worse prognosis. Although not common, spinal trauma in childhood entails a high incidence of severe permanent neurological disability due to direct involvement of the spinal cord. It is necessary for neuoradiologists to be familiar with problems relating to the biomechanics of the spine in childhood since prompt diagnosis may reduce the neurological deficits and allow appropriate management of these young patients.
Proposta di un protocollo di studio neuroradiologico nel follow-up dei tumori del sistema nervoso centrale in età pediatrica
Authors: Elefante A. , Tortora F. , Volpe A. , Manto A. , Caranci F. , Di Salle F. , D'Auria T. , Migliorati R. , Fiorillo A. , Briganti F. , Cirillo S. , Elefante R.
Published: April 2015

This study proposes a study protocol with the timing of neuroradiological investigations in children with CNS Tumours subjected partial or total surgical resection. The follow-up serves to plan possible further surgery and to determine the prognosis and monitor complementary therapy.
Un raro caso di vitreo iperplastico primitivo persistente bilaterale (VPIP)
Authors: Puglielli E. , Splendiani A. , Polito M. , Blasi M.A. , Masciocchi C. , Gallucci M.
Published: April 2015

We describe the magnetic resonance features of a rare case of bilateral persistent primitive vitreous. After an initial MR scan, a follow-up investigation disclosed a stationary picture. Thanks to its multiplanar features, MR allowed the correct identification and characterization of the malformation together with its associated endobulbar changes.

The exceptional presence of a bilateral lesion, described in very few literature reports, makes the diagnosis difficult on a clinical basis. Current neuroradiological techniques offer crucial diagnostic support and allow differential diagnosis. Technical know-how and a knowledge of the symptoms of this disease are essential.
La Risonanza Magnetica muscolare nelle malattie neuromuscolari
Authors: Pichiecchio A. , Cini C. , Egitto M.G. , Berardinelli A. , Mercuri E. , Uggetti C.
Published: April 2015

We describe the main magnetic resonance features of neuromuscular diseases based on a series of 345 patients undergoing muscle MR scans. The study aimed to establish the use of this method in the diagnosis of neuromuscular disease, namely its ability to distinguish neurogenic forms from primary myopathy by analysing the location, extension and distribution of structural changes. A selective muscle involvement was encountered in some myogenic diseases and can be considered a characteristic feature of different diseases and hence an important aid in diagnosis. We propose that MR scanning be included among the instrumental tests required in the diagnosis of neuromuscular disease.
La sindrome di Aicardi-Goutières
Authors: Uggetti C. , Fazzi E. , D'Arrigo S. , Zappoli F. , Lanzi G.
Published: April 2015

We describe the clinical and neuroradiological features of eleven patients with Aicardi-Goutières syndrome, a rare and severe progressive encephalopathy with onset in the first year of life. The syndrome is autosomal recessive with varying clinical presentation and course. Our patients were studied by CT and MR imaging and findings were in agreement with literature reports. Calcification of the basal nuclei was found in 100% of cases and six patients presented a progressive increase in the number and size of the calcifications which were bilateral and largely symmetrical. White matter changes were seen in 76% of cases without a specific pattern of distribution. Early neuroradiological diagnosis of suspect Aicardi-Goutières syndrome is established by ruling out other pathological processes and the site and features of the calcifications rather than the white matter changes is important to then search for typical CSF changes.
Problematiche e contributi nella presa in carico dei pazienti affetti da Sclerosi Tuberosa
Authors: Veneselli E. , Di Comite R.
Published: April 2015

Tuberous Sclerosis Complex (TCS) is a multisystem autosomal dominant disorder, with high spontaneous mutation rate; it is charactherized by very different clinical phenotypes and widespread development of hamartias, or non-growing lesions, and hamartomas, wich can grow as benign tumors and rarely progress to malignances.

We reported the TSC Consensus Conference Diagnostic Criteria, divided into major and minor features (1998), and Recommendations for diagnostic evaluation (1999).

Since the age-dipendent appearance and the frequency of symptoms, their usefulness is limited in pediatric patients.

Then we examined the data about the incidence of clinical features from infancy into childhood, with the aim of improving the diagnostic evaluation and the follow up of pediatric patients.

Therefore, also on the basis of the personal experience, we stressed the opportunity of a flexible clinical approach and the existence of some features stimulating other clinical and basic research studies.
Up-date sulla sclerosi tuberosa
Authors: Balestri P. , Bartalini G. , Caliani B.
Published: April 2015

Tuberous sclerosis is an autosomal dominant multisystem disease caused by two different genes, one located on chromosome 9q34 (TSC1) and the other on chromosome 16p13 (TSC2). The most common major neurological symptoms are epilepsy and mental retardation. Neuroimaging techniques will accurately depict the frequency and extent of anatomical involvement of brain structures. This involvement is the result of impaired control of cell proliferation, migration and differentiation leading to the development of hamartomas in different organs and tissues. We report our findings in a series of 93 patients recruited at the Paediatric Clinic of Siena University Hospital.
Embolization of Spinal Cord AVMs with ASA Supply
Authors: Perini S. , Causin F. , Castellan L. , Casasco A. , Zampieri P. , Beltramello A.
Published: April 2015

Treatment of spinal cord AVMs is always challenging and leads to high risks even with endovascular or microsurgical approach. Risks arise mainly when an “intramedullary” spinal cord AVM fed by anterior spinal artery (ASA) needs to be treated. Superselective catheterization technique and embolization agents represent important risk factors. The aim of this report is to evaluate the results and limits of embolization therapy of these malformations on the basis of our experience. Since 1996 we treated 51 spinal vascular malformations, 29 were true SCAVMs. The main ASA supply was observed in 17 cases. All were intramedullary AVM with “nidus” type appearance. Complete embolization was achieved in 23.5% of cases. Complications related to the procedure were observed in 28% of cases. Our results confirm that ASA embolization is at high risk of hemorrhage and ischemia. We believe that this technique should be reserved for patients with previous hemorrhage and when a high risk of hemorrhagic event is recognized. Moreover, a poor natural history of this illness suggests that conservative treatment is not always recommended. In these cases a fractionated superselective embolization to reduce hemorrhagic events could be a good option.
Diagnosi precoce e trattamento di un caso di disrafismo spinale occulto con “diastematomielia” e doppio seno dermico
Authors: Crispino M. , Zambelloni C. , Fontana A. , Savasta S. , Poggiani C. , Olivetti L.
Published: April 2015

Le malformazioni caratterizzate da divisione del midollo spinale (“Split cord malformation”) sono rare forme di disrafismo spinale occulto che si sviluppano precocemente nel corso della vita embrionale. I pazienti che ne sono affetti presentano elevati rischi di sviluppare deficit neurologici gravemente invalidanti nel corso della vita, per l'ancoraggio midollare sempre presente. Già alla nascita, la maggior parte di essi presenta anomalie cutanee (ipertricosi, nevi, angiomi, fossette o fistole e lipomi sottocutanei) localizzate generalmente in regione lombo-sacrale che costituiscono spesso l'unico segno della sottostante patologia. Descriviamo gli aspetti neuroradiologici e neurochirurgici di un raro caso di divisione midollare associata a tehered cord, doppio seno dermico ed anomalie vertebrali multiple. Neonata da parto spontaneo alla 38° settimana con peso alla nascita di g. 3100 e Apgar 8/10, che presenta stigmate disrafiche cutanee ed una modesta iperreflessia rotulea bilaterale con lieve ipotonia degli arti inferiori. Al 2° giorno di vita viene effettuato studio neuroradiologico encefalo-spinale con Risonanza Magnetica (RM), Tomografia Computerizzata (TC) ed ecografia che mette in evidenza la presenza di una doppia corda midollare con unico rivestimento durale (tipo II di Pang), un duplice seno dermico, a L3-L4 ed a livello coccigeo con ancoraggio midollare ed alcune anomalie vertebrali (vertebra a farfalla a T12 e schisi multiple). A 22 giorni dalla nascita la piccola paziente è stata sottoposta con successo ad intervento chirurgico per disancoraggio del midollo. I reperti operatori hanno confermato l'ipotesi diagnostica neuroradiologica. Nel corso dei mesi successivi sono stati eseguiti controlli clinici e strumentali seriati, compresa una valutazione urodinamica, che non hanno mostrato deficit neurologici o sfinterici. A distanza di un anno la piccola presenta un regolare sviluppo psicomotorio ed è neurologicamente indenne. I disrafismi spinali, comprendono spesso malformazioni complesse che sebbene rari esistono e necessitano di una diagnosi precoce e di un trattamento rapido, prima dell'insorgenza di deficit neurologici gravi ed irreversibili. Le anomalie cutanee rappresentano spesso l'unico segno della malformazione, in particolare nei neonati, nei quali i segni clinici sono assenti o difficilmente valutabili. La diagnostica neuroradiologica (RM in particolare) è del tutto affidabile nell'individuare le cause che determinano l'ancoraggio midollare al fine di favorire un trattamento neurochirurgico efficace, come confermato anche in questa nostra esperienza.
Bridging the Gap between Brain Anatomy and Function with Diffusion MRI
Authors: Le Bihan Denis
Published: April 2015

Water diffusion MRI allows tissue structure to be probed and imaged at a microscopic scale well beyond the usual “millimetric” image resolution, providing unique clues to the fine architecture of neural tissues, and to changes associated with various physiological or pathological states. The leading clinical application of diffusion MRI has been in the study of acute brain ischaemia. With its unmatched sensitivity, diffusion MRI provides some patients with the opportunity to receive suitable treatment at a stage when brain tissue might still be salvageable. Moreover, because diffusion is anisotropic in brain white matter, reflecting its organization in bundles of myelinated axonal fibres running in parallel, diffusion MRI can be used to map out the orientation in space of the white matter tracks in the brain. Diffusion MRI is also a promising tool for the study of brain maturation and development.
Latent Cerebral Venous Drainage Disorders: Etiopathogenesis, Clinical and Neuroradiodiagnostic Symptomatology
Authors: Varsik P. , Şigrai M. , Mihale J. , Buranová D. , Bilickş J.
Published: April 2015

Impaired cerebral venous drainage and latent cerebral venous and sinuses thrombosis are common disorders. We describe five cases of consecutive latent disturbance of cerebral venous drainage and latent or oligosymptomatic cerebral venous and sinuses thrombosis (CVST) disclosing the need for prompt accurate etiological diagnosis. The risk of CVST in the presence of two or more etiological factors is increased. Very frequently the patient's complaints and the clinical picture are oligosymptomatic and poor. In suspicion of impaired cerebral venous drainage, an examination of the cerebral vessels including phlebography is recommended. We assume that CT-Angiography, MR-Angiography or a classical DSA is inevitable in some cases for correct and successful treatment.
MRI Features of Benign Cerebellar Astrocytomas in Children
Authors: Wei G.Q. , Huan Y. , Liu W.P. , Yang Y. , Wang Y.G. , Zhao H.T. , Wu H.Y.
Published: April 2015

We document the MR imaging characteristics of benign cerebellar astrocytomas (BCAs) in children that aid differential diagnosis and surgical planning. The twelve patients ranged in age from two to 16 years (average age ten years). Of 12 tumors, seven were located in the cerebellar hemisphere, four in the vermis, and one in the IV ventricle. All children suffered from hydrocephalus rated as extensive (n = 9) or moderate (n = 3). The tumors ranged in diameter from 23 mm to 68 mm, mean diameter 42 mm. Solid tumors were found in five children, and cystic areas occurred in seven out of 12 patients. Most BCAs were hypointense on T1-weighted scans and hyperintense on T2WI compared with normal brain parenchyma. After contrast injection, BCAs may demonstrate marked (n = 2), moderate (n = 5), or absent (n = 5) enhancement. Hemorrhage and calcification are not common (n = 1, 0, respectively).
Long Term Results of Radiosurgery in Recurrences of Cavernous Sinus Meningiomas
Authors: Valentino V. , Benassi M. , Strigari L.
Published: April 2015

Between 1987 and 1999, radiosurgery was used on 34 patients with recurrent meningiomas of the cavernous sinus. In 12 patients this was either a second recurrence (seven patients) or a third (five patients). Average follow-up time was more than six years (range 4 to 15 years). Five patients could no longer be traced after a brief follow-up period (1–3 years). In 18 patients there was a more than 10% reduction in size of the original meningioma, and complete retrogression in one patient. In another seven cases the meningioma size remained stable, whereas in four cases radiosurgery was ineffectual and the meningioma continued to grow. In short, radiosurgery had a positive effect in 74.52% of patients. Post-operative recurrences of meningiomas tend to develop after decreasing intervals of time, which was also found to be the case in our series of patients. It is therefore significant that in the 25 patients where the meningioma size decreased or remained constant, the time elapsing between the radiosurgery and the last follow-up (averaging more than eight years) was much longer in these individual cases than the interval between their last surgical operation and the recurrence (three years, on average). This fact and its easily imagined consequences, taken together with the results reported in this study, are important in providing an answer to the question of whether radiosurgery can offer a regular alternative to surgical re-operation in recurrences of cavernous sinus meningiomas.
Magnetıc Resonance Imaging Findings of Simultaneous Double Pituitary Adenoma
Authors: Oner A. Y. , Tokgoz N. , Erbas G. , Tali E. T.
Published: April 2015

The simultaneous occurrence of multiple pituitary adenomas is rare, generally discovered at autopsy or during pituitary surgery. We report a case of synchronous bilateral pituitary adenomas, concurrently revealed by MR imaging (MRI) as part of the investigation of the patient's severe persistent headaches. To the best of our knowledge, this is the sixth case diagnosed in vivo by MRI.
CT and MR Findings of Extensive Lumbosacral Hydatid Disease
Authors: Koseoglu K. , Kara N. , Özgün H.
Published: April 2015

Spinal hydatid disease is an uncommon disease encountered in the endemic area. The vertebrae are the bones most involved by Echinococcus granulosus. A 52-year-old patient with low back pain was evaluated by lumbosacral radiography, CT, and MR. Plain radiography showed expansion and destruction of transverse and spinous process. CT and MR revealed bone scalloping of posterior border vertebrae, and multiloculated- multiseptated cysts in the spinal canal, paravertebral soft tissues and sacral bone. The cysts had thin hypointense walls on both T1 and T2-weighted sequences. There is no pathognomonic radiological finding of spinal hydatid disease, but radiological assessment is essential for differential diagnosis and operation planning.
Fetal MR Imaging
Authors: D'Aprile P. , Strada A. , Tarantino A. , Daddario V. , Marotta V. , Aquilino P. , Desantis V. , Brindicci D. , Girard N.
Published: April 2015

Although sonography (US) is the first imaging technique for evaluating the developing fetus, significant limitations exist in the sonographic prenatal diagnosis of many brain disorders and in the evaluation of cerebral anatomy. At present, the role of MR imaging in the diagnosis of prenatal anomalies is confined to determining the underlying cause of non-specific fetal abnormalities detected sonographically, especially in fetal brain malformations, or when US is equivocal or limited. In particular, the major indication for MR study is ventriculomegaly, because this sign could be associated with different anomalies (malformations, ischemic disease and cerebral destructive lesions); other indications for MRI include maternal infections and genetic syndromes. MR imaging is an important adjunctive tool for prenatal imaging in those instances where complex anomalies are suspected by US, when fetal surgery is contemplated, or when a definitive diagnosis cannot be determined. In this work we report our experience of fetal MRI in fetuses with suspect cerebral anomalies previously detected by US.
MRI of Central Nervous System under General Anaesthesia with Laryngeal Mask Airway in Childhood
Authors: Öztürk E. , Cok O. Yalcin , Sezer A. , Gokyar I. , Tuncer B. , Gungor I. , Gunaydin B. , Tali E. T. , Celebi H.
Published: April 2015

Our anaesthetic experience and outcomes in children undergoing magnetic resonance imaging (MRI) scanning are presented. unpremedicated 417 children were included in this study. Heart rate (HR), noninvasive blood pressure (BP) and peripheral oxygen saturation (SpO2) were monitored by MRI-compatible equipment during MRI scanning in all children. Induction of anaesthesia was performed with 4–8% sevoflurane inhalation in 50% nitrous oxide-oxygen mixture using Mapleson D breathing circuit by an MRI-compatible anaesthesia machine. After providing regular spontaneous ventilation, an appropriate sized classic laryngeal mask airway (LMA) was positioned. Then anaesthesia and ventilation were maintained with approximately 1–1.5% sevoflurane inhalation in 50% nitrous oxide oxygen mixture using the circle system. MRI studies of all the children were completed successfully with satisfactory image quality. HR, BP and SpO2 remained within safe limits throughout MRI scanning. Vomiting was observed in 22 children out of 417 which resolved spontaneously without any antiemetic therapy. Oral intake was established within 20 minutes of anaesthesia completion in children. All of the children were discharged within 1 hour after admission to the postanaesthesia care unit. In conclusion, LMA used under general anaesthesia in children undergoing MRI scanning was uneventful allowing satisfactory image quality and prompt discharge of children with far fewer complications resulting from general anaesthesia.
Brainstem Astrocytomas: The Radiosurgical Approach
Authors: Valentino V. , Benassi M. , Strigari L.
Published: April 2015

Between 1987 and 1998, radiosurgery was performed on 20 cases of brainstem gliomas in patients of ages varying from eight months to 56 years, 11 of whom had low grade tumours and nine malignant growths. Six of the cases were children (ranging from eight months to 16 years). Six of the patients had undergone histological examinations. In fourteen cases, diagnosis of infiltrating brainstem tumour, and the distinction between high and low grade gliomas, was determined clinically and in particular through neuroradiology. In the histologically determined cases there was a pylocytic astrocytoma, a fibrillary astrocytoma, an astrocytoma II, two anaplastic astrocytomas and an angioglioma. The mean 25 mm target dose was 15 Gy in low grade tumours and 36 Gy in malignant gliomas. Of the 11 low grade tumour cases, nine patients are in an excellent state of health after follow-ups of between eight and 17 years. The average survival rate for high grade tumour cases was slightly more than 12 months (with a range of four to 25 months). In two cases of low grade glial tumour, the patients had previously undergone unsuccessful fractionated irradiation. The results presented lead to the conclusion that: 1) in cases of diffuse glioma, radiosurgery vs neurosurgery or even fractionated irradiation does not even appear to be an option, but merely a simple decision to use a new form of treatment; 2) neurosurgery may perhaps be an alternative in selected focal or exophytic tumours; 3) neuroradiology techniques, which are also classic methods for distinguishing the specific nature of glial tumours, ‘naturally’ relegate routine brainstem tumour biopsy to the pages of neurosurgical history.
Meningiomas with Unusual Intra-Extracranial Extension: Ectopic Entities?
Authors: Pasqualetto L. , Scuotto A. , Guarnieri G. , D'Avanzo R. , Natale M. , Rotondo M. , Moraci A. , Agozzino L. , Cirillo S.
Published: April 2015

We describe two patients with meningiomas atypically appearing as long-standing forehead and vertex lumps. In both cases, CT scan and MRI identified large neoplasms arising in the frontal and parietal regions respectively with extra-cranial extension through the destroyed calvarium and intracranial development. At surgery in the first case the tumour was found adherent to the external dural layer without involvement of the internal layer thus falling into the ectopic class of meningiomas. In the second case, the dura appeared completely infiltrated by the neoplasm. Histological examination did not reveal any malignancy in either patient. Consequently, osteolysis was no of prognostic value. The role of neuroimaging is discussed, the relevant literature on extracranially protruding meningiomas is reviewed, and the clinical-surgical outcome is described.
Study on the Morphology of Post-Traumatic Intracerebral Hematoma
Authors: Yao Y. , Zhou J.Y. , Liu W.G. , Yang X.F. , Hu Ww
Published: April 2015

We studied the morphology of post-traumatic intracerebral hematoma. The relationship between hematoma morphology parameter-irregular rate (IR) and hematoma enlargement was also studied. One hundred and sixty-five patients with post-traumatic intracerebral hematoma were examined by brain CT scan within 72 h after the onset, and reexamined 120 h after onset. The two hematoma volumes (V1 and V2) were calculated. The curvature computing is proposed to describe IR of the hematoma. The relationship between hematoma IR and hematoma enlargement (V2-V1) was also analyzed. A significant difference was found in IR between patients with interval ≤ 3 hours and other intervals ( P < 0.05, S-N-K method). Hematoma IR had a positive correlation with hematoma enlargement ( P = 0.000; Spearman correlated coefficient, 0.893). It is useful for clinicians to gauge the possibility of hematoma enlargement with the aid of hematoma IR. It is valuable to repeat CT scans in time and apply active treatments in positive cases.
Presurgical Embolization of Intracranial Extra-Axial Tumours Using Glubran 2®: Our Experience in 14 Patients
Authors: Simonetti L. , Raffi L. , Cenni P. , Andreoli A. , Calbucci F. , Leonardi M.
Published: April 2015

This study aimed to define the indications, technique and results of presurgical embolization of intracranial extra-axial tumours using Glubran 2® a new acrylic glue with the CE mark, suitable for permanent embolization of the pathological circulation of tumours. Embolization was performed prior to surgery in seven patients with benign tumours and three patients with malignant lesions. All the procedures were technically feasible and achieved partial or complete embolization of the vascularized lesion without periprocedural complications. Glubran 2® proved easy to use with excellent intravascular penetration achieving permanent embolization. The degree of presurgical embolization in terms of surgical field haemostasis was satisfactory in all cases and correlated to the degree of vascular occlusion achieved.
Intramedullary Cervical Spinal Cord Abscess
Authors: Maffei M. , Simonetti L. , Battaglia S. , Mascari C. , Trocino C. , Leonardi M.
Published: April 2015

Intramedullary abscesses are uncommon with a prevalent incidence in childhood and adolescence. Prognosis is not always favourable. Management entails a combined surgical and medical approach with long-term drug therapy. We describe a patient with rapidly progressive hemiparesis and MR findings of an undefined intramedullary expanding lesion in the cervical spine. Rapid evolution of clinical symptoms, and brain MR disclosing meningitis suggested an abscess, subsequently confirmed by histological analysis.
1HMRS 3 T in vivo and in vitro and Anatomopathological Correlations in Extracerebral Tumours
Authors: Ricci R. , Bacci A. , Tugnoli V. , Tosi M.R. , Agati R. , Marliani A.F. , Messia M. , Ferracini R. , Leonardi M.
Published: April 2015

We describe two patients with extracerebral tumours histologically diagnosed as a metastasis with focal necrosis (case 1) and a meningioma with microcystic features (case 2), examined by proton magnetic resonance spectroscopy. Tumour metabolism did not fit literature reports as lipids were not detected in the metastasis but were found in the meningioma whose in vitro spectrum also showed metabolic abnormalities. This discrepancy may be due to the technique adopted in case 1 and the small amount of tumour necrosis, but it is difficult to account for in case 2. Some explanations are offered but long-term follow-up scans will establish whether the abnormal metabolic features indicative of a negative prognosis are confirmed by the patient's evolution. The cases described do not necessarily call other literature reports into question, but warrant caution in establishing a diagnosis on the basis 1HMRS findings. Spectrum acquisition techniques need to be standardized and short TE measurements are more reliable than those made with long TE.
Preclinical Neuroimaging: An Overview
Authors: Sbarbati A. , Fabene P.F. , Marzola P. , Boschi F.
Published: April 2015

Preclinical applications in neuroradiology are rapidly growing. This work briefly reviews the aims, methods and research fields in which preclinical neuroradiology units are involved. Specifically we will describe applications in pharmacological research, transgenic animals phenotyping, stem cell imaging and molecular imaging. The interdisciplinary approach, typical of preclinical neuroradiology, appears to be useful also in the training of young neuroradiologists.
Bilateral Exostoses of the Internal Auditory Canal
Authors: Unlu E. , Albayram S. , Argimak Y. , Cakir B.
Published: April 2015

Although exostoses of the external auditory canal are not uncommon, those of the internal canal are extremely rare, and only a few cases have been reported in the literature. Several of these cases have been verified with radiologic methods. Our aim is to present this rare pathology detected with CT findings associated with literature.
Embolization of Choroid Plexus Arteriovenous Malformation
Authors: Gupta A.K. , Varma D.R. , Bodhey N.K. , Purkayastha S.
Published: April 2015

Choroid plexus arteriovenous malformations are rare lesions that usually present with intraventricular hemorrhage. Management of these lesions is challenging as their deep location makes them relatively inaccessible for surgical excision. Recent advances in microcatheter technology have made it possible to access these lesions safely for embolization. We report a case of lateral ventricular choroid plexus arteriovenous malformation completely occluded by endovascular treatment.
Leukoaraiosis. A Short Review
Authors: Kapilamoorthy T.R. , Fiorelli M. , Gupta A.K. , Kesavadas C. , Krishnamoorthy T. , Bozzao L.
Published: April 2015

Leukoaraiosis (LA) is the widely accepted definition for the changes in the white matter of the brain frequently detected in the elderly by neuroimaging techniques. LA has a vascular pathogenesis and is a definite contributory factor for stroke, cognitive decline and dementia. Theoretically, though not yet in practice, if these lesions are detected at an early stage treatment can be instituted promptly, thereby preventing a catastrophic event later. Here we concisely review the relevant literature and stress the imaging of LA and its clinical significance.
Primary Intracranial Mixed Germ-Cell Tumors in Adult: MR Findings
Authors: Wei G.Q. , Huan Y. , He H.D. , Sun L.J. , Yang Y. , Yin H. , Zhao H.T.
Published: April 2015

The incidence of primary intracranial mixed germ-cell tumor varies geographically. Preoperative diagnosis is of great importance in treatment planning. We describe the clinical and MRI findings of a case of mixed germ-cell tumors in the suprasellar region with emphasis on the imaging characteristics suggesting the histological diagnosis.
Perfusion and Diffusion Magnetic Resonance Imaging in a Case of Subependymoma of the Lateral Ventricle
Authors: Muccio C.F. , Savarese F. , Bartolini A. , Esposito G.
Published: April 2015

Magnetic resonance brain scan in a 54-year-old man with ingravescent headache disclosed an expansive intraventricular non infiltrating process, hypointense in T1 and hyperintense in T2, without signal intensification after the injection of a paramagnetic contrast agent. The lesion was studied with diffusion and perfusion sequences. The Apparent Diffusion Coefficient and the Signal/Time Relative Intensity curves after perfusion study were analyzed. Diffusion images confirmed the solid nature of the lesion, while perfusion images displayed the vascular proliferation within the lesion. Diffusion and perfusion sequences were helpful in suggesting the neuroradiological diagnosis of subependymoma, subsequently confirmed by pathologic testing following the neurosurgical tumour resection.
Transradial Cerebral Angiography: Technique and Indications
Authors: Marina R. , Quilici L.
Published: April 2015

Transradial angiography is a useful tool for diagnostic and interventional neuroangiographic procedures. It is routinely used for coronary angiography but there are few reports on the technique in neuroradiolocgical literature. Between April 2004 and February 2005 we enrolled 67 patients for transradial selective cerebral catheterization. We performed 56 diagnostic procedures, four interventional and seven failed accesses. Sheaths were used in all cases ranging in size from 4F to 6F. Standard shape angled Berenstein and Simmons (I, II) 4F catheters were used for three- and four-vessel diagnostic arteriography and 40° 5F and 6F guide catheters for interventional procedures (two external carotid, one vertebral embolization and one left cervical ICA stenting). Periprocedural complications included failure to access the radial/brachial artery (five patients), and transient radial artery spasm with pain (two patients). There were no major complications and/or deficits related to cannulation of the radial artery. Compared with transfemoral and transbrachial approaches, transradial access is a less invasive and safer technique for neuroangiography. Anticoagulant or antiplatelet therapy need not be discontinued for this method. All major vessels can be accessed for diagnostic studies and interventions in the vertebral system and in selected conditions of carotid anatomy are facilitated.
Persistent Trigeminal Artery Associated with Intracranial Vertebral Artery Fenestration in a Patient with Carotid-Cavernous Fistula
Authors: Purkayastha S. , Gupta A.K. , Jayadevan E.R.
Published: April 2015

The association of persistent trigeminal artery (PTA) with intracranial vertebral artery fenestration is very rare. The commonest associations of PTA are with intracranial aneurysms, arteriovenous malformations, absence of internal carotid artery and vertebral arteries. We describe a case of persistent trigeminal artery associated with intracranial vertebral artery fenestration in a patient with right-sided type 1 carotid-cavernous fistula. To our knowledge, this is the first report of such an association.