bluuebunny/crossref_metadata_2025 huggingface dataset:
Ruptured Giant Basilar Artery Aneurysm in a Comatose Adolescent: Successful Obliteration Using Intraoperative SSEP, BAER, and MEP Monitoring
Authors: Nwagwu C.I. , Mathews M.S. , Scott J.A. , Denardo A.J. , Horner T.G.
Published: January 2017

Giant basilar aneurysms are infrequently seen in children. We present the endovascular management of an adolescent who presented comatose with pinpoint pupils due to a ruptured giant basilar trunk aneurysm. A noncontrast head CT disclosed a large prepontine lesion with brainstem hemorrhage. Catheter angiography showed a 4.5 cm irregular, fusiform basilar trunk aneurysm. With SSEP, BAER, and MEP monitoring, the patient underwent bilateral temporary vertebral artery occlusion, followed by GDC embolization of the aneurysm. Postprocedure internal carotid angiograms showed adequate blood supply to the basilar apex via patent posterior communicating arteries. On postprocedure day two, the patient was following commands.

The remainder of his hospital course was uneventful. Postoperative angiograms showed no residual filling of the aneurysm. At 12 months the patient was neurologically intact and at baseline function as an honor student and follow-up angiogram showed persistent occlusion of the aneurysm from the circulation. Successful endovascular treatment has been considered a less invasive and safer alternative to surgical management of some complex vascular lesions. While most reports on reversing basilar artery flow have been carried out in awake patients with neurological examinations, this is not possible in a patient presenting in a comatose state. This report suggests that SSEPs, BAERs and MEP may be of use in such patients in safely carrying out basilar artery occlusion.
Unruptured Intracranial Aneurysms
Authors: Raymond J. , Nguyen T. , Chagnon M. , Gevry G. ,   Trial on Endovascular Aneurysm Management (TEAM) collaborative group
Published: January 2017

In the absence of level one evidence, the treatment of unruptured intracranial aneurysms is grounded on opinions. Results of the largest registry available, ISUIA (the International Study on Unruptured Intraacranial Aneurysms) suggest that surgical or endovascular treatments are rarely justified. Yet the unruptured aneurysm is the most frequent indication for treatment in many endovascular centres. In preparation for the initiation of a randomized trial, we aimed at a better knowledge of endovascular expert opinions on unruptured aneurysms.

We administered a standard questionnaire to 175 endovascular experts gathered at the WFITN meeting in Val d'Isère in 2007. Four paradigm unruptured aneurysms were used to poll opinions on risks of treatment or observation, as well as on their willingness to treat, observe or propose to the patient participation in a randomized trial, using six questions for each aneurysm.

Opinions varied widely among lesions and among participants. Most participants (92.5%) were consistent, as they would offer treatment only if their estimate of the ten-year risk of spontaneous hemorrhage would exceed risks of treatment. Estimates of the natural history were consistently higher than that reported by ISUIA. Conversely, treatment risks were underestimated compared to those reported in ISUIA, but within the range reported in a recent French registry (ATENA). Participants were more confident in their evaluation of treatment risks and in their skills at treating aneurysms than in their estimates of risks of rupture entailed by the presence of the lesion, the latter being anchored at or close to 1% /year.

The gulf between expert opinions, clinical practices and available data from registries persist. Expert opinions are compatible with the primary hypothesis of a recently initiated randomized trial on unruptured aneurysms (TEAM), which is a benefit of endovascular treatment of 4% compared to observation over ten years. Only data from a randomized trial could provide convincing objective evidence in favour or against preventive treatment of unruptured intracranial aneurysms.
Endovascular Trapping for a Giant Aneurysm of the Cervical Internal Carotid Artery: A Case Report
Authors: Nakayama H. , Iwabuchi S. , Hayashi M. , Yokouchi T. , Terada H. , Samejima H. , Ueda M.
Published: January 2017

We describe a case of giant cervical internal carotid aneurysm successfully treated by endovascular trapping. A 57-year-old woman with a history of maxillary contusion seven years before presented with pharyngeal discomfort during swallowing. MRI revealed a 4 cm mass in the right parapharyngeal space. A common carotid angiogram revealed a giant aneurysm with a wide neck originating from the cervical internal carotid artery; kinking of the internal carotid artery was noted at a point distal to the carotid bifurcation. Analysis of cerebral blood flow by SPECT during a balloon occlusion test showed no hypoperfusion areas, and the patient underwent endovascular trapping. There were no neurological or other complications after the procedure. A follow-up MRI revealed complete thrombosis of the aneurysm. Our results show that endovascular trapping for pseudoaneurysm of the cervical internal carotid artery can be a reliable and effective treatment in patients who tolerate a balloon occlusion test.
CT Guided Aspiration of a Cervical Synovial Cyst
Authors: Kostanian V.J. , Mathews M.S.
Published: January 2017

Synovial cysts are cystic dilations of synovial sheaths with or without anatomical continuity within a joint space that occasionally involve the lumbar spine. Image-guided aspiration has been used successfully in the management of lumbar synovial cysts. Synovial cysts of the cervical spine are rare, tend to present with myelopathic symptoms, and are classically treated using operative intervention. We report a novel approach for cervical synovial cyst aspiration under CT guidance.

A 66-year-old woman presented to the clinic complaining of severe pain, tingling, and dysesthesia in her right upper extremity in the C5, C6 and C7 nerve root distribution. MR imaging of her cervical spine showed a synovial cyst within the right C6-C7 neural foramen with significant compression and obliteration of the C7 nerve root. The patient underwent CT-guided aspiration of the cyst using a double needle technique, where one needle was used to open up the epidural space while another aspirated the cyst. This was followed by epidural injection of local anesthetic and steroids.

Immediately after injection, the patient experienced complete relief of her right forearm pain, tingling, and dysesthesias. The patient tolerated the procedure well and there were no postprocedure complications. At four year follow-up the patient is free of any symptoms.

Image-guided aspiration of cervical synovial cysts is feasible using CT fluoroscopy. Aspiration of these cysts combined with epidural steroid injection can provide long-lasting symptomatic relief in some patients.
Local Intra-Arterial Fibrinolysis in Acute Basilar Artery Occlusion
Authors: Enomoto Y. , Yoshimura S. , Kitajima H. , Tamakawa N. , Iwama T.
Published: January 2017

Acute basilar artery (BA) occlusion is typically associated with poor outcome; however newer diagnostic and treatment modalities have the potential to improve prognosis. In this study, six patients with acute BA occlusion were followed and the effectiveness of local intra-arterial fibrinolysis (LIF) and subsequent percutaneous transluminal angioplasty (PTA) with a balloon catheter were assessed. Of the six patients with BA occlusion observed in this study, two had extended brain stem infarction on diffusion weighted image (DWI) and were treated conservatively. The other four patients received LIF at an average of 5.2 hours from occlusion onset. Three of these four patients received additional PTA with compliant balloon catheters. All four of the patients who received LIF achieved recanalization of the BA trunk and showed a favorable clinical outcome. These findings suggest that LIF is beneficial for selected patients with BA occlusion and that successful recanalization is indicative of a good prognosis. Because of the poor prognosis associated with conservative therapy, we conclude that LIF should be attempted even for comatose patients or in cases of prolonged occlusion time.
Analysis of the Properties of Guiding Catheters Used in Endovascular Neurointervention
Authors: Imaoka T. , Itoh K.
Published: January 2017

The backup force is one of the most important properties of the guiding catheter in modern endovascular neurointervention employing rigid or bulky devices. Several guiding catheters were examined with regard to their backup force. Each guiding catheter had unique characteristics and neither an increase in its diameter nor increase in the backup force was directly proportional. The combined use of guiding catheters (coaxial guiding catheter) led to some improvement of the backup force, and the combination of the 6Fr Envoy and 8Fr Guider Softip exhibited the best performance. This article provides some scientific background as a means to select the appropriate catheter for beginners as well as accomplished operators.
Radiation Exposure during Cerebral Artery Aneurysm Coil Embolization: The Current Situation and Measures to Prevent Radiation Injury
Authors: Shohji T. , Ishibashi T. , Murayama Y. , Saguchi T. , Ebara M. , Irie K. , Takao H. , Abe T.
Published: January 2017

Coil embolization is the treatment of choice for cerebral artery aneurysms at our institution. The duration of a fluoroscopic study and frequency of radiation exposure are varied, and the safety measures against radiation injury have not yet been established. Guidelines about radiation injury prevention with IVR have been published. However, there is not yet a detailed report for the head region. We also report our measures to try to reduce the amount of radiation exposure during the embolization procedure in our institution.
Efficacy of Carotid Artery Stenting
Authors: Sato H. , Matsuo K. , Miwa H. , Hirohata T. , Kohno M. , Mayanagi Y. , Kato N. , Takigawa T. , Tsunoda T. , Kobayashi E.
Published: January 2017

Carotid Artery Stenting(CAS) was performed for 51 lesions in 46 patients for almost clinically symptomatic stenotic (>70%)lesions of cervical carotid arteries. The lesions involved the contralateral occlusion cases in eight cases, the bilateral stenotic cases in six cases and the ipsilateral internal carotid artery stenotic cases in two cases. In all cases, endovascular technique was performed from a transfemoral approach under local anesthesia primarily. Under systemic heparinization, CAS was performed using a self-expanding stent system. For the pre-stenting and post-stenting dilatation, percutaneous transluminal angioplasty (PTA) balloon catheters were used. The balloon was inflated up to the pressure of six to ten atoms for 20 to 30 seconds. After CAS, stenotic lesion dilated successfully in all cases (0–20% residual stenosis; mean, 5.5%) even if in the case of the contra-lateral occlusion cases, more than 90% severe stenotic cases, and the tortuous artery cases. The cerebral protection system was always used, mainly distal blocking balloon type. Only one symptomatic complication occurred after CAS. Follow-up ultrasonic carotid echogram was performed in 30 cases. No cases showed restenosis (more than 50% restenosis). Clinical follow up was performed in all cases for one to 41 months (mean, 15.2 months) and no clinical deterioration such as TIA or stroke occurred. CAS is technically feasible and can be performed with relatively low morbidity even if complicated stenotic cases. It may be useful, but the increase the number of patients and the long-term follow-up are necessary to evaluate the safety and usefulness of this method.
Experience in Endovascular Treatment of Recurrent Chronic Subdural Hematoma
Authors: Ishihara H. , Ishihara S. , Kohyama S. , Yamane F. , Ogawa M. , Sato A. , Matsutani M.
Published: January 2017

Most cases with chronic subdural hematoma (CSDH) are treated by simple irrigation and drainage, then more than eighty percent of them result in good recovery. But we sometimes encounter intractable cases with hematoma re-collection, which is considered of repeated bleeding from macrocapillary in the hematoma capsule. Embolization of the middle meningeal artery (MMA) is considered to be useful to eliminate the blood supply to this structure. The authors experienced seven cases of intractable CSDH treated by MMA embolization and no recurrence took place in all cases for up to 15 months. Endovascular treatment may be a good alternative modality for recurrent CSDH.
Efficacy of Endovascular Surgery for Unruptured Internal Carotid Artery Aneurysms Presenting with Cranial Nerve Symptoms
Authors: Suzuki S. , Kurata A. , Kan S. , Yamada M. , Niki J. , Yuzawa I. , Sato K. , Iwamoto K. , Oka H. , Fujii K.
Published: January 2017

Whether endovascular surgery is able to reduce the mass effects of unruptured aneurysms is still controversial, although some reports have suggested efficacy in cases of internal carotid artery aneurysms with cranial nerve palsy. Here we assessed outcome in a series of cases.

Between April 1992 and April 2005, 18 patients with unruptured internal carotid artery aneurysms presenting with cranial nerve palsy were treated by endovascular surgery. The patients were two males and 16 females aged from 19 to 84 (mean 59.6 years). Aneurysms were located in the cavernous portion in 14, at the origin of the ophthalmic artery in one and at the origin of P-com in three. The aneurysms were all embolized using Guglielmi detachable coils, Interlocking detachable coils, Cook's detachable coils or Trufill DSC and detachable Balloons were applied to occlude the proximal parent artery. We analyzed the efficacy of endovascular surgery for such aneurysms retrospectively.

The mean aneurysm size was 21.4 mm and the mean follow-up period was 57.7 months. Palsy of IInd cranial nerve was evident in three patients, of the IIIrd in eight, of the Vth and Vth in one each, and of the VIth in nine. Post embolization occlusion was complete in nine patients and neck remnant in the other seven.

Regarding complications of endovascular surgery, one case (5.6%) showed TIA after embolization. Overall 11 (46%) cranial nerve symptoms showed complete resolution, eight (33%) showed some improvement, and five (21%) were unchanged. In three cases (12.5%), the symptoms worsened after treatment. The shorter the duration of symptoms was a factor predisposing to resolution of symptoms. In complete resolution cases, the timing of treatment after symptoms appeared and the time of complete resolution were in proportion.

These results showed that there is no difference in reduction of mass effects between surgical clipping and endovascular surgery for unruptured internal carotid artery aneurysms. With endovascular surgery, the rapidity of treatment after symptoms is the most important factor for successful results.
Evaluation of Carotid Plaque Composition by Computed Tomography Angiography and Black Blood Magnetic Resonance Image
Authors: Haraguchi K. , Houkin K. , Koyanagi I. , Nonaka T. , Baba T.
Published: January 2017

The purpose of this study was to evaluate the composition of a carotid plaque quantitatively by computed tomography (CT) angiography and qualitatively by black blood magnetic resonance imaging (MRI). Thirty-eight patients with high-grade carotid artery stenosis were included in this study. Ultrasonography, CT angiography and black blood MRI of the cervical carotid artery were performed, and the CT number was measured in Hounsfield units (HU). The average CT number of the 15 unstable plaques (39.5%) was 27.7 ± 7.5 HU and that of the 23 stable plaques (60.5%) was 60.4 ± 20.8 HU (p <0.0001). In the 23 patients with stable plaque, 21 demonstrated isointensity in T1 and T2 in the black blood MRI (p <0.0001).

By using CT angiography and MRI, precise images of the pathology of the carotid arterial wall can be obtained. It is possible to evaluate the components of a carotid artery plaque with high reliability by quantification of the CT number in CT angiography and performing black blood MRI as well as in carotid ultrasonography.
Vascular Microanatomy of the Pontomedullary Junction, Posterior Inferior Cerebellar Arteries, and the Lateral Spinal Arteries
Authors: Mercier Ph. , Brassier G. , Fournier H-D , Picquet J. , Papon X. , Lasjaunias P.
Published: January 2017

This study of 25 brains at the pontomedullary junction defined the different possible origins of the perforating arteries and lateral spinal arteries in relation to the posterior inferior cerebellar arteries (PICAs).

- If the PICA emerges from the common trunk of the AICA-PICA coming from the basilar artery, it never gives perforating arteries or a lateral spinal artery on the lateral surface of the brain stem but supplies blood to a part of the ipsilateral cerebellar hemisphere.

- If the PICA arises extradurally at C1, it never gives perforating arteries for the lateral surface of the brain stem, but it gives pial branches for the posterior surface of the medulla oblongata and is always the origin of the lateral spinal artery.

- If the PICA emerges in the intradural vertebral artery, it is the source of the perforating arteries for the lateral surface of the brain stem and of the blood supply of the ipsilateral cerebellum.
Traumatic Carotid Cavernous Fistula Concomitant with Pseudoaneurysm in the Sphenoid Sinus
Authors: Huai R.C. , Yi C.L. , Ru L.B. , Chen G.H. , Guo H.H. , Luo L.
Published: January 2017

This study was designed to elucidate the generating mechanism, diagnosis and treatment of traumatic carotid cavernous fistula (tCCF) concomitant with pseudoaneurysm in the sphenoid sinus. Six cases of tCCF concomitant with pseudoaneurysm in the sphenoid sinus were analyzed in this study. Clinical history, neurological examination, CT and MRI scans, pre- and postembolization cerebral angiograms and follow-up data were included.

All patients presented with massive epistaxis and symptoms of tCCF. The pseudoaneurysms and fistulas were occluded with detachable balloons, and preservation of the parent artery in two cases. One patient also had indirect carotid cavernous fistula (CCF) on the contralateral side embolized by transfacial vein approach with microcoils. Complete symptom resolution was achieved in all cases, without procedure related complications. During the follow-up period all patients returned to work.

Falling from a high speed motorcycle without wearing a helmet may be one of the main causes of this disease. The site of impact during the accident mostly localizes in the frontal and lateral of the orbit. Intracavernous sinus hypertension of tCCF combining with fracture of the lateral wall of the sphenoid may lead to the formation of a pseudoaneurysm in the sphenoid sinus. MRI scan is very helpful in the diagnosis of this disease before the patient receives angiography. Detachable balloon occlusion of the pseudoaneurysm and fistula is a safe and efficient treatment.
A Randomized Trial Comparing Platinum and Hydrogel-Coated Coils in Patients Prone to Recurrence after Endovascular Treatment (The PRET Trial)
Authors: Raymond J. , Roy D. , White P.M. , Fiorella D. , Chapot R. , Bracard S. , Kallmes D.F. ,   THE ICONE COLLABORATIVE GROUP
Published: January 2017

New coils have been designed to preserve the safety of coil embolization while improving on long-term efficacy. There is currently no scientific evidence that one type of coil material is better than another.

The recurrence problem may be more pressing in certain types of patients, such as patients with large aneurysms or those already presenting with angiographic recurrences.
Unruptured Intracranial Aneurysms
Authors: Raymond J. , Guillemin F. , Proust F. , Molyneux A.J. , Fox A.J. , Claiborne J.S. , Meder J.-F. , Rouleau I. ,   The Trial On Endovascular Aneurysm Management (Team) Collaborative Group
Published: January 2017

The preventive treatment of unruptured aneurysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice?

The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blinding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5–1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more.

Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem.
Clinical and Radiological Features of Posterior Communicating Artery Aneurysms
Authors: Sola T. , Benítez E. , Vivas E. , Cuellar H. , Nasis N. , Guimaraens L.
Published: January 2017

Treatment of unruptured intracranial aneurysms based on critical size and predictive risk factors is generally accepted, but several factors contribute to the clinical outcome in a patient with subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm. We decided to evaluate other parameters that might contribute to the clinical outcome of patients with a ruptured posterior communicating artery aneurysm. A retrospective review of the medical records of patients diagnosed and/or treated of cerebral aneurysms at our institution was carried out. We selected patients with Pcom aneurysms that presented with SAH and reviewed conventional and tridimensional angiographic images to determine its anatomical orientation and correlated the data with amount of SAH and clinical presentation and outcome. A total of 112 Pcom aneurysms presented with SAH and were included in this study. 92 patients were women and 20 were men, with a mean age of 57 years (range 25–81). According to anatomical orientation, 43 were inferolateral, 30 lateral, 13 superolateral, three inferomedial, two in medial location, two superomedial, 11 inferoposterior, five posterior and three superoposterior. Aneurysms in superolateral location are to be watched carefully, it is likely that this location joins several conditions for these aneurysms to grow faster or have a higher hemodynamic stress which makes them more at risk of rupture and contribute to a worse clinical outcome.
Initial Clinical Experience with a New Biointegrative Cement for Vertebroplasty in Osteoporotic Vertebral Fractures
Authors: Siemund R. , Nilsson L.T. , Cronqvist M. , Strömqvist B.
Published: January 2017

Polymethylmethacrylate, as a widely used material for vertebroplasty, has several drawbacks such as heat development and high allergenic potential. In order to avoid these drawbacks ceramic cement materials have been developed.

The purpose of this study was to evaluate a new biointegrative material for vertebroplasty in osteoporotic vertebral fractures regarding pain relief, safety aspects and technical feasibility.

The injectable bone substitute Cerament™ SpineSupport has been developed for vertebroplasty of osteoporotic vertebral fractures. The aim of the product is to provide mechanical stability by cured calcium sulfate dehydrate during a period of several weeks and to act as an osteo-conductive support by hydroxyl apatite particles.

Inclusion criteria were a stable single vertebral fracture at levels Th5 to L5, verified by CT and MRI, and not older than four weeks, in osteoporotic patients aged 60 years or older. Bipedicular vertebroplasty technique was used. Follow up included CT directly after treatment and after two month and pain assessment (VAS) pre and post procedure after two weeks and one month.

Seven patients (age range 62 – 96 years, mean 73.9, five women, two men) were treated at levels T 8 (n=1), T 12 (n=4) and L1 (n=2). The average injected volume was 1.9 ml (range 0.2 – 4 ml). No material or procedure-related complications were observed. An average height loss of the treated vertebral bodies of 3.6 mm (range 1.5 – 5.4) was seen two months after treatment as compared to pre-treatment CT. Pain assessment by VAS resulted in an improvement from mean 69 prior treatment to 37 the day post treatment, 42 after two weeks and 30 after one month.

Initial results indicate that Cerament™ SpineSupport is safe and effective in the treatment of acute osteoporotic vertebral body fractures. Further studies with long-term follow-up are needed to confirm these results and to prove the concept of osteoconduction with hydroxyl apatite particles.
Evaluation of the Solitaire System in a Canine Arterial Thromboembolic Occlusion Model: Is it Safe for the Endothelium?
Authors: Park Soonchan , Hwang Seon Moon , Song Joon Seon , Suh Dae Chul , Lee Deok Hee
Published: January 2017

The Solitaire system has recently been increasingly used for acute stroke treatment in which the endothelial safety immediately after its use has not been evaluated. This study was performed to evaluate the endothelial status when using a Solitaire system in a canine arterial occlusion model.

Thromboembolic occlusion of both internal maxillary arteries was achieved in five mongrel dogs. In each animal, the Solitaire system (ev3, Irvine, CA, USA) was used for primary thrombectomy on the right side and for temporary stenting on the left side. Efficacy was assessed by comparing the recanalization rates, and safety was assessed using angiographic and microscopic assessments. Endothelial injuries were evaluated with light microscopy (LM) and scanning electron microscopy (SEM).

Successful revascularizations were observed following primary thrombectomy in all five animals (100%) and after temporary stenting in two (40%). There was no incidence of vasospasm or vessel perforation in either group. Distal migration of the clot occurred in two animals that underwent primary thrombectomy. Endothelial injury was seen after primary thrombectomy in two animals (40%) and after temporary stenting in one (20%). The lesions presented as defects of the internal elastic lamina on LM and denudation of the wavy endothelial surface on SEM.

During mechanical thrombectomy, the Solitaire system can cause endothelial injury both in primary thrombectomy and temporary stenting. Primary thrombectomy is likely to have a higher recanalization rate with increased endothelial injury.
Endovascular Treatment of Traumatic Carotid Cavernous Fistula with Balloon-Assisted Sinus Coiling
Authors: Andrade Gustavo , De Souza Moysés L. Ponte , Marques Romero , Silva José Laércio , Abath Carlos , Azevedo-Filho Hildo R.C.
Published: January 2017

This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail.

Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a “U-turn” maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon.

Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months).

An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe.
Stent Placement to Treat Ruptured Vertebral Dissecting Aneurysms
Authors: Chen Yong-An , Qu Rong-Bo , Bian Yu-Song , Zhu Wei , Zhang Kun-Peng , Pang Qi
Published: January 2017

Conventional endovascular treatment may have limitations for vertebral dissecting aneurysm involving the origin of the posterior inferior cerebellar artery (PICA). We report our experiences of treating vertebral dissecting aneurysm with PICA origin involvement by placing a stent from the distal vertebral artery (VA) to the PICA to save the patency of the PICA.

Stenting from the distal VA to the PICA was attempted to treat ruptured VA dissecting aneurysm involving the PICA origin with sufficient contralateral VA in eight patients.

The procedure was successfully performed in seven patients with one failure because of PICA origin stenosis, which was treated with two overlapping stents. In the seven patients, PICAs had good patency on postoperative angiography and transient lateral brainstem ischemia represents a procedure-related complication. Follow-up angiographies were performed in seven patients and showed recanalization of the distal VA in three patients without evidence of aneurysmal filling. There was no evidence of aneurysm rupture during the follow-up period, and eight patients had favorable outcomes (mRS, 0–1).

Placing a stent from the distal VA to the PICA with VA occlusion may present an alternative to conventional endovascular treatment for vertebral dissecting aneurysm with PICA origin involvement with sufficient contralateral VA.
Bilateral Cervical Spinal Dural Arteriovenous Fistulas with Intracranial Venous Drainage Mimicking a Foramen Magnum Dural Arteriovenous Fistula
Authors: Hetts Steven W. , English Joey D. , Stiver Shirley I. , Singh Vineeta , Yee Erin J. , Cooke Daniel L. , Halbach Van V.
Published: January 2017

We describe a unique case of bilateral cervical spinal dural arteriovenous fistulas mimicking an intracranial dural arteriovenous fistula near the foramen magnum. We review its detection via MRI and digital subtraction angiography and subsequent management through surgical intervention. Pitfalls in diagnostic angiography are discussed with reference to accurate location of the fistula site. The venous anastomotic connections of the posterior midline spinal vein to the medial posterior medullary vein, posterior fossa bridging veins, and dural venous sinuses of the skull base are discussed with reference to problem-solving in this complex case. The mechanism of myelopathy through venous hypertension produced by spinal dural fistulas is also emphasized.
Variability in Evolution and Course of Gunshot Injuries to the Neck and Impact on Management
Authors: Lee Stephen R. , Metwalli Zeyad A. , Yevich Steven M. , Whigham Cliff J. , Benndorf Goetz
Published: January 2017

This study reports the differences in evolution and course of multiple pseudoaneurysms (PAs) and an axillary arteriovenous fistula (AVF) after penetrating vascular trauma due to shotgun injury to the head and neck.

We describe the unusual case of a young man who, following penetrating shotgun injuries to the head and neck, developed multiple PAs of the common carotid, vertebral and superficial temporal arteries as well as an axillary AVF. Serial angiographic follow-up studies documented differences in time of occurrence, evolution and course of these lesions. This allowed for tailored management using endovascular (AVF, superficial temporal artery PAs) and conservative (carotid and vertebral PAs) treatment. No complication occurred and complete cure of all lesions was achieved and documented after seven months.

Time of occurrence, evolution and regression of penetrating vascular injuries can differ significantly even in the same patient. Close angiographic follow-up helps not only detect a lesion with delayed occurrence, but also provides a practical basis for decision-making for optimal therapeutic management.
Pseudomeningocele after Traumatic Nerve Root Avulsion
Authors: Pascual-Gallego Maria , Zimman Horacio , Gil Alberto , López-Ibor Luis
Published: January 2017

Traumatic brachial plexus complete avulsions and the subsequent formation of pseudomeningoceles are a well-known entity that usually remains asymptomatic. Pseudomeningocele is due to the dural sleeve encasing the damaged roots and the spinal liquid that may accumulate locally or in the supraclavicular soft tissues. The pseudomeningocele, added to the associated lesion of the plexus and usually the surrounding vessels, may become difficult to manage. We describe the novel management of a traumatic pseudomeningocele using an endovascular technique.
«Interventional Neuroradiology: A Neuroscience Sub-Specialty?»
Authors: Rodesch Georges , Picard Luc , Berenstein Alex , Biondi Alessandra , Bracard Serge , Choi In Sup , Feng Ling , Hyogo Toshio , Lefeuvre David , Leonardi Marco , Mayer Thomas , Miyashi Shigeru , Muto Mario , Piske Ronie , Pongpech Sirintara , Reul Jurgen , Söderman Michael , Suh Dae Chul , Tampieri Donatella , Taylor Allan , Terbrugge Karel , Valavanis Anton , Van Den Berg René
Published: January 2017

Interventional Neuroradiology (INR) is not bound by the classical limits of a speciality, and is not restricted by standard formats of teaching and education. Open and naturally linked towards neurosciences, INR has become a unique source of novel ideas for research, development and progress allowing new and improved approaches to challenging pathologies resulting in better anatomo-clinical results. Opening INR to Neurosciences is the best way to keep it alive and growing. Anchored in Neuroradiology, at the crossroad of neurosciences, INR will further participate to progress and innovation as it has often been in the past.
Therapeutic Infiltration of the Facet Joint in Minor Intervertebral Disease
Authors: Longo M. , Blandino A. , Granata F. , Rizzo D. , Vinci S. , Vermiglio M.
Published: January 2017

A CT-guided infiltration technique of the facet joints was employed on a group of 20 patients suffering from sciatica without any signs of morphostructural alteration of the facet joints, secondary to Minor Intervertebral Disease (MID).

The typical flouroscopically guided intra-articular facet arthrography has been substituted by a CT-guided technique that privileges therapy rather than diagnosis.

The study involved 20 patients between 29 and 57 years of age (average 44.5), of both sexes (16 females and four males). The average time which elapsed from onset of symptomatology was 9.5 months.

At seven days after the first treatment subjective results were considered excellent by 11 patients (55%), good by one (5%) and satisfactory by one (5%). Six out of 20 patients (30%) failed to gain any relief of symptoms. Only one patient (5%) had a worsening of pain. Clinical evaluation by the physician at the same time showed a good result in 11 patients (55%), satisfactory in two (10%). In six patients (30%) the symptomatology was unchanged.

At 4 months the subjective results were excellent in three (15%), good in six (30%) and satisfactory in two (10%). Nine (45%) had no positive results. The clinical examination was excellent in two (10%), good in seven (35%), satisfactory in two (10%) and without any relief of symptomatology in nine (45%).

These results encourage the use of CT-guided infiltration that, together with the small amount of contrast medium injected into the joint space, make it a safe technique for patients, avoiding or reducing complications.
Dural Arteriovenous Shunts Involving the Sphenoparietal Sinus
Authors: Ezura M. , Takahashi A. , Mizoi K.
Published: January 2017

A 40-year-old male suffered transient global amnesia and was diagnosed as having a very rare location of dural arteriovenous shunt (dAVS) involving the right sphenoparietal sinus.

The feeding pedicles of dAVS were not only arising from the right external carotid system, including the middle meningeal artery, but also the right internal carotid system including the ophthalmic artery. The dAVS drained into the right sphenoparietal sinus, right vein of Labbe, and right basal vein of Rosenthal through numerous dilated temporal cortical veins.

The arteriovenous shunt itself was located at the dura around the right superior ophthalmic fissure and a large varix received direct shunting blood flow from the right sphenoparietal sinus.

The dAVS was cured by drainer clipping following transarterial embolisations. A dAVS with cortical venous drainage is considered to have a higher risk of haemorrhage and venous infarction than the others and thus warrants treatment even if the clinical symptom is minimal. If the dAVS has a single drainer, it will be easily cured by way of drainer clipping.

Preoperative embolisation makes clipping easier and safer. Intraoperative angiography is useful because preoperative angiography may not necessarily show the complete angioarchitecture around the lesion.
Spontaneous Polymerisation of Cyanoacrylate/Lipiodol Mixtures Causing Failed Embolisation
Authors: ApSimon H.T. , Bartlett A. , Phadke R. , Khangure M.S.
Published: January 2017

In vitro experiments to investigate spontaneous polymerisation of n-butyl-2-cyanoacrylate when mixed with non ionic oily contrast medium are reported.

The results suggest an interaction between the mixture components which is unique to one particular batch of Lipiodol Ultrafluid and Histoacryl n butyl cyanoacrylate.

The interaction cannot be reproduced with other batches of Lipiodol Ultrafluid nor with an alternative preparation of n-butyl-2-cyanoacrylate. Implications for the use of the materials in neuro-interventional practice are discussed.
Selective Intra-Arterial Thrombolysis for Embolic Complications of Cerebral Endovascular Therapy
Authors: Picard L. , Bracard S. , Maffei L. , Anxionnat R. , Prada E. , Burdin D. , Per A.
Published: January 2017

Cerebral thrombo-embolic complications seldom occur during intracranial endovascular therapeutic procedures. Yet, despite a systemic preventive regimen of pre-operative intravenous acetylsalicylic acid and effective systemic heparinisation, we encountered seven complications of this type over a period of five years, a 3.7‰ incidence (7/1858).

Local intra-arterial thrombolysis performed immediately after the thrombo-embolic complication resulted in complete recanalization in five cases and partial recanalization in two. CT scans performed 24 hours after thrombolysis were normal in six of the seven patients. Only one female patient with partial recanalization showed a limited cortical infarct in the parietal distribution of the middle cerebral artery territory.

In all seven cases recanalization of the occluded vessel resulted in a return to the baseline initial neurological status.

This short series demonstrates the usefulness of emergent thrombolysis dealing with the thrombo-embolic complications of angiography or endovascular therapy. These results are in agreement with these experimental data showing that early recanalization can prevent macroscopically visible infarcts.
Percutaneous Therapy of a Post-Surgical Suboccipital Cerebrospinal Fluid Fistula with Fibrin Glue
Authors: Patel M.R. , Louie W. , Rachlin J.
Published: January 2017

The successful therapy of a suboccipital cerebrospinal fluid fistula by the percutaneous introduction of fibrin glue under computed tomographic guidance is described.
Endovascular Treatment of a Ruptured Intracranial Arterial Aneurysm in a 12-Year-Old Child with Recessive Polycystic Kidney Disease
Authors: De Blasi R. , Lasjaunias P. , Rodesch G. , Alvarez H.
Published: January 2017

A 12-year-old boy with recessive polycystic kidney disease and congenital hepatic failure, presented intracranial subarachnoid haemorrhage, due to the rupture of a laterobasilar tip aneurysm. In addition, he presented a left-sided middle cerebral unruptured aneurysm demonstrated during the screening procedure.

Our patient is a boy, like most children with intracranial aneurysms, but differs from children with intracranial aneurysms in polycystic kidney disease. The age of bleeding was low (actually the second youngest case reported), with a good Hunt and Hess grade at admission.

The localization of the aneurysm is exceptionally posterior (laterobasilar tip); in our case as intracranial aneurysms can be multifocal at that age. Renal function and blood pressure were normal. The endovascular GDC approach achieved a good result and excellent clinical outcome. Although most of what is known in this disease belongs to the autosomal dominant form, it is unclear whether the risk of a demonstrated unruptured intracranial aneurysm is the same as the risk of SAH from a non demonstrated one. It even seems that bleeding during follow-up in patients with polycystic kidney disease mostly occurs from non previously demonstrated intracranial aneurysms9.
Physicochemical Characteristics of Molecules and Their Diffusion across Human Vaginal Mucosa
Authors: Van Eyk A.D. , Van Der Bijl P. , Moll L.M.
Published: January 2017

The diffusion rate of permeant molecules through mucosal tissue depends on the physicochemical characteristics of the molecules themselves as well as the properties of the tissue. In this study the diffusion kinetics of various molecules was examined through intact as well as de-epithelialised human vaginal mucosa. The molecules studied included tritium-labelled water, 17β-estradiol, reduced-arecoline, vasopressin, oxytocin, bradykinin, tacrolimus, cyclosporin A, dihydro-alprenolol, cimetidine and benzylpenicillin. Freshly harvested human vaginal tissue was frozen in liquid nitrogen and stored at −85°C. A flow-through diffusion apparatus was used for the in vitro permeability studies (24 h, 20°C, 1.5 ml/h). The mean estimated – or mean steady-state flux values for all the molecules studied across intact human vaginal mucosa, were generally found to be lower than those of the corresponding de-epithelialised tissue. Using an F-test and comparing whole curves, statistically significant differences in the diffusion rates of tacrolimus, reduced-arecoline, vasopressin, bradykinin, benzylpenicillin, water and cimetidine were found when comparing intact and de-epithelialised vaginal mucosa. Generally, smaller permeant molecules diffused at a higher rate than larger molecules. The epithelial layer retarded the diffusion rate of molecules carrying charges at physiological pH. Damage to the epithelial layer did not necessarily increase the diffusion rate of all molecules tested and small lipophilic molecules did not necessarily diffuse at higher rates than hydrophilic molecules.
Elastase II Gene Encoding as Inflammatory Molecules in Acute Myeloblastic Leukemia
Authors: Ahangari G. , Shamsodin N. , Chavoshzadeh Z. , Moghadam K.A. , Ghavamzadeh A. , Nazarian S.H.
Published: January 2017

Acute myeloblastic leukemia (AML) is characterized by uncontrolled proliferation with the bone marrow (BM) of malignant myeloid progenitors arrested in their maturation process and the egress of these abnormal cells into the circulation. There is evidence that neutrophil production is a balance between the proliferative action of granulocyte-colony-stimulating factor (G-CSF) and a negative feedback from mature neutrophils. Recently, there have been reports on mutations in neutrophil elastase (ELA2) gene in genomic DNA of cyclic neutropenia. These patients developed acute myeloblastic leukemia. Therefore, we hypothesized that elastase may play role in the abnormal AML. Peripheral blood was obtained from 42 patients with acute myeloblastic leukemia and 30 healthy individuals. Total RNA was isolated using RNA standard techniques from freshly separated cells by polymorphoprep. RNA was analyzed by employing PCR amplification of reverse transcribed using a total of ten specific primers. We amplified five exons of ELA2 gene separately and sequenced each exon. Mutational analysis was carried out by directed capillary sequencing method. We found no mutation in 42 Acute myeloblastic leukemia patients compared to healthy individuals. Interestingly, we found heterozygote 50% single nucleotide polymorphism (SNP) in exon II codon 44 of healthy individuals but not in AML patients. It was a silent mutation G to A substitution but no changes in amino acid sequences. The codon sequence was GCG that changed to GCA.
Artificial Light-Induced Cytokine Gene Expression in Rabbit Cornea in vivo: Effect of Ocular Drops Containing Flurbiprofen
Authors: Basli E. , Goulas A. , Karampatakis V. , Karoutis A. , Varsamidis K. , Komninou A. , Mirtsou-Fidani V. , Kokkas B.
Published: January 2017

The purpose of this study is to examine the effect of artificial sunlight on the gene expression of TNF-α, IL-6 and IL-8 in rabbit cornea in vivo, as well as the potential of an ocular anti-inflammatory formulation containing sodium flurbiprofen to suppress this effect. New Zealand Albino rabbits were subjected to acute exposure of their eyes to irradiation emitted from a light bulb commonly used for artificial tanning purposes with and without topical application of a commercially available formulation containing sodium flurbiprofen. Semi-quantitative RT-PCR was used as a means of estimating gene expression. The gene expression of IL-6 and IL-8 was found statistically significantly increased at 24 hrs post-exposure time (p = 0.003 and 0.006, respectively), as was that of TNF-α albeit in a non-statistically significant manner. A sodium flurbiprofen (0.03%) formulation was found to effectively reduce the light-induced upregulation of all three cytokines in the rabbit cornea.
Rheumatoid Arthritis: Time Disjoints
Authors: Bruzzese V.
Published: January 2017

“Time disjoints” is the best way to define how aggressive Rheumatoid Arthritis (RA) is concerning damage to the joints, and it also implies that the sooner the therapy is started, the better the prognosis that can be achieved in changing the natural outcome of the disease and in preventing disability.