bluuebunny/crossref_metadata_2025 huggingface dataset:
Malformazioni artero-venose intracraniche
Authors: Beltramello A. , Zampieri P. , Piovan E. , Rosta L. , Alessandrini F. , Grazioli A. , Pizzini F. , Martines V.
Published: April 2015

Al giorno d'oggi, il bilancio diagnostico neuroradiologico degli angiomi intracranici si fonda su tre principali tecniche: Tomografia Computerizzata (TC), Risonanza Magnetica (RM), Angiografia, eventualmente implementate da studi flussimetrici (ad esempio: Xenon-TC).

La TC è molto utile negli esami di emergenza e/o in quelli di screening.

La superiorità della RM nel dimostrare la precisa localizzazione anatomica e le relazioni del nido della MAV delle sue arterie afferenti e delle vene di drenaggio è probabilmente il vantaggio più importante rispetto alla TC e all'Angiografia.

Le tecniche di RM funzionale consentono la mappatura dei principali sistemi funzionali encefalici al fine di delineare le loro precise relazioni anatomiche con la MAV.

L'Angiografia rimane la sola tecnica che può fornire l'informazione vascolare ed emodinamica dettagliata necessaria per pianificare il trattamento chirurgico o endovascolare delle M AV.

La presenza di emorragia precedente o in atto è reperto di importanza fondamentale per decidere se asportare chirurgicamente la MAV o trattarla conservativamente, a causa dell'elevata incidenza di risanguinamento nei Pazienti con esordio emorragico o in quelli con anamnesi di pregressa emorragia. La RM, con la sua straordinaria sensibilità agli effetti paramagnetici dell'emosiderina, può apportare un contributo molto importante alla gestione terapeutica dei Pazienti in un numero significativo di casi.
MAV cerebrali
Authors: Scienza R. , Pavesi G.
Published: April 2015

Vi sono 2 motivi per cui la MAV cerebrali si pongono come un problema neurochirurgico particolarmente difficile da affrontare. In primo luogo l'indicazione al trattamento (e con quali metodiche); e in secondo luogo l'obiettiva difficoltà tecnica che queste lesioni presentano alla chirurgia.

Quali sono le MAV che si giovano di un trattamento chirurgico? Questa decisione si basa sulla storia naturale, la cui previsione è tuttora deducibile più dalle modalità d'esordio clinico che dagli aspetti morfologici.

Sulla base dei dati della letteratura sono state redatte delle tabelle di calcolo per il rischio individuale di emorragia nell'arco di una vita che sono uno strumento imprescindibile per affrontare questi delicati problemi terapeutici in maniera razionale.

Per quanto concerne il rischio chirurgico sono stati identificati precisi fattori di rischio morfo-funzionali che permettono una quantificazione preoperatoria del rischio di mortalità e morbilità cui può andare incontro il paziente, una volta operato.

Inoltre, la terapia delle MAV è oggi un intervento multidisciplinare, in quanto nel percorso decisionale si inseriscono anche le opzioni di tecniche alternative quali il trattamento endovascolare e la radiochirurgia. Attualmente il nostro orientamento è quello di riservare alle tecniche di embolizzazione un ruolo di ‘preparazione’ al trattamento definitivo, sia esso chirurgico o radioterapico.

Le nostre osservazioni sulla terapia chirurgica delle MAV cerebrali si basano su 175 casi personalmente operati.

La chirurgia delle MAV cerebrali richiede una alta specializzazione nella microchirurgia vascolare affiancata da una adeguata struttura organizzativa. L'esperienza personale può orientare nella indicazione al miglior trattamento possibile, senza tuttavia pretendere di rappresentare un algoritmo decisionale assolutamente attendibile e standardizzabile. Infatti, mancano studi randomizzati di terapia radiochirurgica, endovascolare o microchirurgica, in grado di definire i criteri di trattamento. Questi studi, che richiedono una collaborazione multicentrica, sono necessari per stabilire la prognosi dei pazienti portatori di MAV cerebrali.
Preoperative Assessment for Carotid Artery Stenosis: Utility of a Combined Diagnostic Approach by Dynamic MRA and CTA
Authors: Muto M. , Bonsignore R. , Esposito G. , Di Gaeta A. , Galasso L. , Chiusano R. , Palmieri A.
Published: April 2015

Dynamic Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA) represent two non-invasive techniques which can perform a pre-therapeutic evaluation of carotid artery disease. Ultrasound (US) is the screening technique for this type of pathology and after US results, surgeons or endovascular therapists need more information for a correct therapeutic approach. We performed a combined diagnostic approach with CTA and dynamic MRA to reduce the need for DSA in which permanent and transitory neurological side effects are still possible and to evaluate the efficacy of these two diagnostic modalities.

We performed dynamic MRA and CTA in 80 patients with carotid disease in which a US examination showed the presence of more than 60% stenosis. Dynamic MRA was performed with a 3D coronal volumetric acquistion with a dedicated head-neck coil, 2.5 mm thickness and 18 s acquisition time after contrast media injection to obtain only the visualization of the arterial phase from the origin of the epiaortic vessels through the bifurcation of the siphon without overlap with the venous phase. CTA was done with a spiral technique with contrast media injection (120 ml- 3ml/s) from C6 through the skull base.

In 60 patients, we found the same degree of stenosis between carotid CTA and US examination.

In eight cases, US showed an occlusion of the internal carotid artery (ICA) while CTA reported severe stenosis between 85–90%.

Two cases showed a 85% stenosis of the ICA, while CTA and dynamic MRA disclosed ICA occlusion. CTA showed parietal thrombus and arterial wall calcifications very well.

Dynamic MRA overestimated the stenosis in 85% of the patients, almost always in patients with a stenosis greater than 65–70% and in seven cases also showed an abnormal signal intensity of the origin of the epiaortic vessels or of the intracavernous segment of the ICA that was confirmed by DSA only in four patients. With three patients, it was not possible to perform CTA or MRA because of incorrect transit time evaluation or poor patient cooperation.

The combined diagnostic approach by CTA and Dynamic MRA can be adequate to give a correct pre-therapeutic evaluation in patients with carotid disease; in doubtful or uncooperative cases, DSA is still required.
La RM nell'anatomia del plesso brachiale
Authors: Pellicanò G. , Centi N. , Capaccioli L. , Brizzi E. , Sgambati E. , Del Seppia I. , Villari N.
Published: April 2015

Nello studio dell'anatomia del plesso brachiale la RM è l'esame di scelta in rapporto alle principali caratteristiche della metodica: possibilità di eseguire le scansioni su tutti i piani dello spazio, elevato contrasto intrinseco e grazie al costante miglioramento della tecnologia, strati sottili con elevata risoluzione spaziale.

La sequenza SE T1 dipendente sul piano sagittale è sicuramente quella con il più alto contenuto informativo: le varie diramazioni sono infatti riconoscibili come strutture ad intensità di segnale intermedia tra l'arteria e la vena succlavia con cui mantengono un rapporto anatomico costante e l'elevatà intensità di segnale del tessuto adiposo circostante. Il piano coronale obliquato secondo l'orientamento delle radici nervose fornisce informazioni sul primo tratto del decorso del plesso a partire dalla fuoriuscita delle radici che costituiscono il plesso dai forami di coniugazione. L'uso di bobine di superficie phased array ha permesso di ottenere una buona risoluzione spaziale associata ad un elevato rapporto segnale-rumore. In particolare la bobina tipo sinergy spine ha consentito anche un buon comfort per il paziente anche nel caso di studio di entrambi i plessi brachiali. È da ritenere che la possibilità in un futuro immediato, di impiegare in RM, multiple bobine di superficie dedicate al plesso brachiale, incrementerà ulteriormente le conoscenze anatomiche del plesso base indispensabile, anche in questo campo, per un corretto approccio allo studio della patologia della regione del plesso brachiale.
Siringomielia famigliare
Authors: Duca S. , Fabiani L.
Published: April 2015

La siringomielia, è una patologia del midollo spinale costituita da cavitazioni centro-midollari a sede cervicale, dorsale, lombare e talora bulbare. La cavità può prender origine direttamente dal canale ependimale (idromielia) oppure generare dalle adiacenze del canale ependimale (siringomielia propriamente detta). Eziopatogeneticamente si distinguono forme secondarie (relative a processi espansivi, sequele sclerofibrotiche di processi infettivo-infiammatori, esiti di traumi) e forme idiopatiche di verosimile natura disembriogenetica. Dalla letteratura internazionale i casi famigliari di siringomielia sono stimabili in circa il 2% circa della totalità dei casi. È stata studiata una famiglia composta da dieci membri (padre, madre ed otto fratelli) nella quale sono stati evidenziati clinicamente e strumentalmente tre casi di siringomielia a sede dorsale. In tutti e tre i casi, la siringomielia non era associata ad altre patologie malformative. I tre soggetti affetti da siringomielia, tutti maschi, presentavano una sintomatologia deficitaria sensitiva e motoria a carico degli arti inferiori e sono stati valutati clinicamente ed a mezzo di RM mirata all'encefalo ed al midollo nella sua totalità. Il caso sindromico più grave, è stato sottoposto ripetutamente ad interventi neurochirurgici di marsupializzazione della cavità siringomielica. Lo screening neuroradiologico, è stato, poi, esteso ad altri tre fratelli componenti la famiglia oggetto di studio: una femmina, affetta da lieve sintomatologia disestesica agli arti inferiori e due maschi, entrambi asintomatici, risultati tutti negativi all'indagine RM. Due fratelli, soggettivamente asintomatici, infine, hanno rifiutato ogni indagine clinica e neuroradiologica.

Dal punto di vista epidemiologico è importante rimarcare come sia possibile un'implicazione di fattori genetici e geografici nel determinismo delle forme non sporadiche di siringomielia.
Functional Evaluation of the Operated Lumbar Spine with Axial Loaded Computed Tomography (AL-CT)
Authors: Cartolari R.
Published: April 2015

This study evaluated Axial Loaded-CT (AL-CT) of an operated spine (with and without instrumentation) to assess the limits and possibilities of this diagnostic imaging procedure.

We considered 100 patients divided into two groups: Group 1: 89 patients, evaluated only post-operatively; Group 2: 15 patients who underwent AL-CT before and after lumbar spine instrumentation with different devices, for the purpose of correcting spinal instability. Some patients came at first observation after previous conventional surgery and were enrolled in both groups.

A satisfactory evaluation of the spine was attained in all the patients, even in the presence of beam-hardening artifacts associated with stainless steel posterior fixation.

The evaluation of the conventionally operated spine disclosed the residual stability of the studied segments and allowed a comparison of any abnormal intersegmental movement. The comparison between pre- and post-surgical scans in the instrumented spines enabled the evaluation of: the stability of the surgically stabilized segment; the “internal” stability of the implant; the relative stability of the adjacent spinal levels; the degree of correction of the presurgical instability/deformity.

AL-CT seems to be able to image the operated spine clearly, even when instrumented, showing even minimal residual abnormal movements at and adjacent to the operated level(s). The functional aspects of the examination (axial loading) allowed a good evaluation of the post-surgical load transmission patterns even in the presence of large stainless steel implants.
Endovascular Treatment of Cerebral Aneurysms
Authors: Bradač G.B. , Stura G. , Bergui M.
Published: April 2015

Balloon occlusion of parent vessel and direct coiling are the two endovascular techniques routinely used and commonly accepted as alternatives to surgery for treatment of the cerebral aneurysm in many patients. Based on our experience and what is reported in the literature, the various aspects concerning techniques, difficulties, risks, are described. In comparison to surgery, the endovascular approach is a relatively new technique, which is still in evolution. To date, there is no objective indication regarding the method to be used in a given case. The experience and attitude of the involved team still play an essential role.
Use of a Wire-Directed Microcatheter, without Guiding Catheter or Introducer, to Perform Both Diagnostic and Therapeutic Neuroradiologic Procedures in Neonates and Infants
Authors: Ricciardi G. K. , Granata F. , Vinci S. , Biondi A. , Pitrone A. , Longo M.
Published: April 2015

Performing both diagnostic angiography and endovascular treatments in infants and neonates may be a challenge. The choice of materials represents one of the major difficulties. We present two cases of newborns and one of an infant in which an on-the-wire microcatheter with hydrophilic coating was used without any guiding catheter nor sheath in the management of three different pathologies.

A 24 gauge cannula, a 0.014-inch micro-guidewire and a hydrophilic-coated wire-directed microcatheter (Tracker Excel 14, Boston Scientific/Target Therapeutics, Freemont, CA, USA) where the only tools used to perform angiographies and subsequent treatments. One of the patients had a rapidly growing facial haemangioma resistant to medical therapy. One had a posterior cranial fossa pial fistula and another had a vein of Galen malformation.
Surgical Treatment of Carotid Artery Stenotic Disease
Authors: Lanza G.
Published: April 2015

Starting from historical considerations, the evolution of carotid surgery is analyzed from its origin, when indications and methods used to rely on the insights of operators to date when indications, influenced by improvements in diagnostic and therapeutic techniques, must match the evidence coming from controlled trials. Current indications are herein produced for symptomatic carotid stenosis, which are considered standard, for asymptomatic carotid stenosis and endovascular procedures, which have yet to be defined. Also indications for carotid surgery in emergency are provided, a chapter which has recently been rediscovered and proposed with good results.
Angioplasty and Stenting of the Cervical Carotid Bifurcation
Authors: Bonaldi G.
Published: April 2015

Over a period of 46 months, 71 cervical carotid bifurcation stenotic lesions were treated by angioplasty and/or stenting. The stenosis was atherosclerotic in 61 cases, post-surgical or postradiation in ten cases. The initial technical choice was that of primary stenting without cerebral protection; this attitude has been modified in recent cases by use of a protection balloon or filter. A technical success rate of 98% was achieved (71 cases treated out of 73 attempted). From the angiographic point of view, in all cases good restoration of the luminal diameter was obtained. There were three completely regressive minor strokes (4.2%), and one major stroke (1.4%). A follow-up of at least 1 year is available for 50 patients; a restenosis of less than 50% occurred in four (8%). In conclusion, angioplasty and stenting of the cervical carotid bifurcation is feasible in relatively safe conditions. However, analysis of the case complicated by a major stroke and the evolution of protection devices in recent years suggest the use of such devices for brain protection. The most suitable condition for endovascular treatment is considered to be an intermediate stenosis, i.e. with a residual lumen for safe passage of the devices used, without need for dangerous friction on plaque surfaces. The most dangerous phase of the treatment is dilation of the plaque by the balloon; deployment of an oversized stent without dilation is desirable whenever possible.
Valutazione peri-operatoria e post-operatoria del trattamento endovascolare nella patologia steno-ostruttiva carotidea
Authors: Causin F. , Castellan L. , Iannucci G. , Puzzuoli A. , Perini S. , Danieli D. , Toso V.
Published: April 2015

We evaluated peri-operative and 30 days post-operative efficacy of endovascular treatment of carotid stenosis performed with percutaneous angioplasty and stenting.

From June 1996 to October 2002 we performed 156 endovascular treatments of carotid artery stenosis in 150 symptomatic patients with ages ranging from 40 to 87. We treated with angioplasty and stent 110 patients with primitive carotid plaque (70.5%) and 44 patients with non-atherosclerotic lesion: 34 were post-surgical restenosis (21.7%) of the carotid bifurcation after carotid endarterectomy, 6 post-actinic stenosis, 2 carotid stenosis in Takayasu disease and 2 post-stent restenosis. Twelve patients were treated before cardio-surgical intervention and 8 were stroke patients performed in acute phase. Angioplasty alone was done in 11 cases (7.1%) while stent placement was performed in 145 cases (92.9%). In 71 patients (50%) the endovascular treatment was performed during distal cerebral protection.

We achieved the dilatation of the stenotic tract in all the patients with residual stenosis less than 30% in 98% of cases. Two permanent neurological deficits (1.28%) and 4 transient neurological deficit (3.2%) were observed. One patient died 20 days after the procedure because of cardio-surgical complications. Fifteen patients (9.6%) complained a transient orthostatic hypotension. No new clinical complication was observed during 30 days follow-up. Our results with the endovascular treatment of the carotid stenosis appear not significantly different from recent literature data and main surgical publications and trails about the carotid endarterectomy in symptomatic patients. Our complication rate is similar to surgery, probably because of our patient selection and to the evolution of the materials for endovascular therapy. Our results underline the efficacy and safety of the endovascular technique with possible extension of its indications to primitive stenosis in selected cases and in the treatment of acute stroke.
STENT-PTA delle stenosi di carotide “Estreme”
Authors: Marina R.
Published: April 2015

To date, our series of PTA-STENT interventions to treat carotid artery stenosis comprises 170 consecutive patients. Of these, 30% had a degree of carotid stenosis between a residual lumen < 15% and virtual pre-occlusion. The overall historical mortality/morbidity of 3.4% in our series is deemed acceptable for selection in our series which includes only high surgical risk patients. In view of this, the paper gives a detailed description of the interventional technique routinely used to treat this subgroup of patients.
MR Imaging and Proton MR Spectroscopy of the Brain in Behçet's Disease
Authors: Cellerini M. , Bartolucci M. , Mortilla M. , Mascalchi M. , Li Gobbi F. , Marchione T. , Salvati G. , Del Seppia I. , Emmi L.
Published: April 2015

Cerebral MR imaging (MR) and proton-MR spectroscopy (H-MRS) data are lacking in neurologically asymptomatic patients with Behçet's disease (BD). Aim of the following work was to assess MR and H-MRS characteristics of brain involvement over time in patients with BD without clinical neurological involvement. Forty cerebral MR and 12 H-MRS examinations obtained over a one to nine year follow-up in 17 patients with (group A n=9) or without (group B n=8) neurological involvement were retrospectively reviewed. Four group-B patients had a normal first MR examination whereas all group-A and four group-B patients showed single (n?3) or multiple (n=10) subcortical white matter foci of signal change. Large midbrain, basal ganglia or subcortical white matter lesions were depicted in six group-A patients. Comparison between initial and last MR examinations revealed 28 new small-to-medium size lesions. Over the course of the study, lesion enhancement was seen in five patients all belonging to group A. NAA/Cr and Cho/Cr ratios of supraventricular white matter did not show significant differences between patients and healthy controls or between group-A and group-B patients. Clinically silent cerebral involvement in the form of small-to-medium size subcortical lesions may be present at MR examination in BD patients. Large brainstem and basal ganglia lesions associated with overt neurological symptoms are characteristic of the disease. H-MRS of cerebral normal-appearing white matter does not show any significant metabolic change in BD.
Evaluation of MRI-detected White Matter Changes in Relation to Hemodialysis Duration and Renal Transplantation
Authors: Kurt A , Firat A , Aildere Am , Aytekin C , Benli S , Özmen I , Özdemir N , Haberal M
Published: April 2015

Compared to the normal population, renal transplant recipients and end-stage renal disease (ESRD) patients on hemodialysis have a higher incidence of white matter changes (WMC) on brain magnetic resonance imaging (MRI). The lesions appear as focal or patchy areas in the periventricular white matter. Both these patient groups are known to be affected by accelerated atherosclerosis, which produces small-vessel disease. This may lead to thromboembolic complications that cause these white matter lesions. This study retrospectively assessed the frequency of MRI-detected WMC in ESRD patients on hemodialysis and kidney recipients, and correlated the rates with hemodialysis duration and post-transplantation interval. Focal and patchy type lesions were distinguished, and the frequencies of these were studied. Also, in the respective groups, comparisons were made among patients with different hemodialysis durations and post-transplantation intervals. The results showed that specifically focal lesions increase in parallel with hemodialysis duration, but there was no statistical relationship between WMC and post-transplantation interval.
The Cochlear Aqueduct De Aquaeductibus Auris Humanae: Part I
Authors: Palmieri A.
Published: April 2015

The cochlear and vestibular aqueducts were described in detail by D. Cotugno in 1775. This paper reports the salient parts of his description and emphasizes their interest in studying labyrinthine syndromes by CT and MR investigations.
Linfoistiocitosi eritrofagocitica
Authors: Caranci F. , D'Amico A. , Briganti F. , Migliorati R. , De Fusco C. , Poggi V. , Cirillo S. , Elefante R.
Published: April 2015

Erithrophagocytic lymphohistiocytosis is a rare disease characterized by exaggerated histiocytic proliferation and activation12 and multisystem involvement including visceral organs, lymph nodes, bone marrow and central nervous system4.

Magnetic Resonance (MR) examination was performed in 10 patients with previously diagnosed Erithrophagocytic lymphohistiocytosis. This study was aimed at assessing MR accuracy in the identification and characterization of central nervous system lesions.

MR findings show a good correlation with areas of parenchymal and meningeal lymphohistiocytic infiltration5, demonstrating diffuse white matter abnormalities in the early stages and necrotic areas with parenchymal volume loss as terminal findings4. In addition, MR allows the follow-up after chemotherapy and bone marrow transplantation2,3.

Although rare, EL should be differentiated from other pediatric patchy white matter abnormalities5.
Normal Development and Malformations of the Cerebellar Cortex
Authors: Bernardi B. , Roncaroli F.
Published: April 2015

The cerebellum is one of the first structures of the central nervous system that begins differentiation and one of the last to reach maturity. Neurogenesis of granular neurons is largely postnatal and cellular organization continues several months after birth. This protracted maturation causes susceptibility to developmental abnormalities. Such abnormalities encompass structural malformations and even cerebellar tumors. Current knowledge on the development of the cerebellar cortex is increasing. Cerebellar cortex development includes proliferation, migration, neuronal differentiation, guided axonal growth, neuronal map formation and synaptogenesis. These steps follow different timing and modalities compared to neocortex. The high resolution Magnetic Resonance (MR) improved the in vivo depiction of the cerebellar cortex and its developmental malformations. Correlation between neuroimaging and clinical findings as well as neurogenetic allowed practical classification of cerebellar malformations. The proposed morphology-based classifications appear incomplete and need continuous revision. In this review, we have followed a neuroradiological schema in order to reconcile previous classifications.

Sviluppo normale e malformazioni della corteccia cerebellare
Disfunzioni corticali e sotto-tentoriali nella Sclerosi Tuberosa
Authors: Grasso A. Coppolaro , De Rinaldis M. , Matricardi M. , Brinciotti M.
Published: April 2015

Visual evoked potentials (VEP) and brain stem acoustic evoked potentials (BAEP) were studied in eight children with tuberous sclerosis (four boys and four girls, average age 4.5 years) comparing them with a control group of 21 healthy children (ten boys and 11 girls). The patients had an increased average latency of VEP (IV component or P2; p < .01694) and BAEP (right V wave = p < .001145; left V wave = p < 013792; right I-V interpeak = p < .000543; left I-V interpeak ? p < .009854). Impaired responses were common in both VEP (80%) and BAEP (85%). In addition, altered BAEP were also present in patients without subtentorial structural abnormalities. Evoked potentials serve as a sensitive test for early diagnosis of tuberous sclerosis.
Sindrome di Joubert
Authors: Tavani F. , Gallo C. , Roversi M.F. , Pugliese M. , Palmieri D. , Piaggi S. , Mavilla L. , Ferrari F.
Published: April 2015

Joubert's sundrome is a rare cerebellar malformation belonging to the group of rhom-boencephaloschisis and characterised by varying degrees of hypoplasia of the cerebellar vermis or complete agenesis. We describe an infant referred to us at six months of age for oculomotor apraxia and delayed psychomotor development. We focus on the neuroradiological features essential to diagnosis of Joubert's syndrome. The absence of hyperpnea in the neonatal period and prematurity deemed responsible for initial episodes of central apneas, prevented early diagnosis.
Re-Equilibration Not Arthrodesis. Contribution to the Functional Treatment of Lumbar Vertebral Instability
Authors: Scarfò G.B. , Muzii V. F.
Published: April 2015

Vertebral instability is a clinical condition not yet satisfactorily defined in its multiple aspects: functional, morphological, anatomopathological and pathophysiological. The term “vertebral instability” is used in a non-rigorous manner by exponents of highly invasive spinal surgery and arthrodesis is still considered the most effective therapy. However, attitudes may be beginning to change.

We tackled the problem of vertebral lumbar instability from a functional point of view, correlating the morphological alterations with the functional ones and considering them not as “excessive” but as anomalous movements. We assessed this condition in 26 patients by conventional methods and by biomechanical study “in vivo” with axial-loaded computed tomography (ALCT). The instability was associated with various conditions of disc degeneration, stenosis and spondylolisthesis. All patients underwent dynamic neutralization with the DynesysTM system; 13 patients also underwent microsurgical decompression.

At follow-up (average 24 months), lumbar pain was found to have ceased in 20 patients (77%) and decreased in six (23%). In all cases, neurological symptoms diminished markedly and root pain disappeared. Spondylolisthesis disappeared in nine cases out of 14 and was reduced in five; in another four cases it was visible only by ALCT and disappeared at follow-up. In all cases, postoperative X-ray showed that the disc plates of the stabilized vertebrae were parallel, with slight widening of the disc spaces above and below, and there was also improvement in lumbar lordosis. Post-operative ALCT, carried out in eight cases, demonstrated neutralization of the anomalous movement and restoration of biomechanics similar to normal.
Trans-Craniotomic Embolization of Dural Arteriovenous Fistulae in the Transverse and Sigmoid Sinuses
Authors: Simonetti L. , Trossello M. Pastore , Cenni P. , Acciarri N. , Leonardi M.
Published: April 2015

We describe two patients with dural fistulae treated by venous embolization with coils. We combined a direct neurosurgical approach to the venous segment with endovascular occlusion.

This technique offers the pathophysiologically most appropriate treatment (venous approach) which is relatively simply and safe for the patient. The combined approach avoids the technical complexity of traditional neurosurgery and the not always straightforward and long catheterization via the retrograde transfemoral venous route of the traditional endovascular procedure.
Brain Tumors, Update 2003: Imaging and the “New ‘New W.H.O.’”
Authors: Osborn Anne G.
Published: April 2015

The “new ‘new’ W.H.O.” schema of classifying and grading brain neoplasms is coming into worldwide use. Neuroradiologists should become familiar with new concepts such as primary and secondary glioblastoma, malignant progression of astrocytoma, the simplified classification of meningioma, and newly-identified neoplasms such as atypical teratoid/rhabdoid tumor and chordoid glioma.
Non-Homogeneous Increased Intensity of the Cortex on PROPELLER DW MRI in Creutzfeldt-Jakob Disease
Authors: Mori H. , Aoki S. , Abe O. , Hayashi N. , Masumoto T. , Yoshikawa T. , Ohtomo K. , Hirakawa M. , Ugawa Y.
Published: April 2015

Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction (PROPELLER) is one of the newer magnetic resonance imaging (MRI) methods developed to correct motion artifacts. PROPELLER uses a radial scan variation of the fast spin-echo sequence and spatial inconsistencies to be corrected using self navigation and an averaging effect for low spatial frequencies. We report and assess the imaging findings in a restless patient with Creutzfeldt-Jakob disease with a point mutation at codon 180 in prion protein DNA using PROPELLER diffusion-weighted MRI.
MRI Features of Leptomeningeal Melanosis
Authors: Wei G.Q. , Huan Y. , He H.D. , Yang Y. , Liu Y.L. , Wu H.Y. , Zhao H.T. , Ge Y.L.
Published: April 2015

Neurocutaneous melanosis (NCM) is a rare congenital dysmorphogenesis characterized by large or multiple congenital benign melanocytic nevi and diffuse or local leptomeningal involvement of abnormal pigmentation. Intracranial lesions may occur in the leptomeninges and cerebral parenchyma. The clinical presentations are nonspecific, and the prognosis is extremely poor for symptomatic patients, even in the absence of malignant melanoma. At present, the best imaging method for diagnosing leptomeningeal melanosis (LMM) is magnetic resonance imaging (MRI), and the T1-weighted images are the best to demonstrate the features of NCM in the central nervous system. We describe the MRI features of LMM in a case of NCM.
Value of Computed Tomographic Angiography in the Detection and Preoperative Planning of Intracranial Aneurysms
Authors: Elçi M. , Gelal F. , Bezircioğlu H.
Published: April 2015

We aimed to determine 1) the value of computed tomographic angiography in the detection of intracranial aneurysms compared with surgery and 2) the role of computed tomographic angiography in preoperative planning of intracranial aneurysms by comparing computed tomographic angiography findings with surgical observations regarding size and shape of the aneurysm, size of the neck and orientation of the dome. Fifty patients suspected to harbour intracranial aneurysms underwent computed tomographic angiography and surgery. Computed tomographic angiography and surgery findings were compared in terms of presence of and surgically important features required in preoperative planning. The sensitivity of computed tomographic angiography in the detection of aneurysms when compared with surgery was 96%. Out of the 50 aneurysms identified by computed tomographic angiography, computed tomographic angiography findings and surgical observations were in full agreement regarding the location and shape of the aneurysms (kappa = 1.0). The agreement was slightly less in depicting the size of the neck (kappa = 0.967), size of the aneurysm and orientation of the dome (kappa = 0.95). Although digital subtracted angiography is the standard method in the diagnosis of intracranial aneurysms, computed tomographic angiography has proved to be of great value in the management of presumed aneurysm patients. Computed tomographic angiography achieves a high sensitivity rate in detecting aneurysms and provides excellent anatomical information required for pretreatment planning.
Radiation-Induced Optic Neuropathy
Authors: Natale M. , Muras I , Cioffi F.A. , Bernini F.P.
Published: April 2015

Optic neuropathy resulting in permanent visual loss is an infrequent delayed complication of radiation therapy. Misdiagnosis of such a lesion may be due to the aspecifical clinical course, the usual tardive appearance and to a possible role of the initial pathology in visual pathways impairment. A radiation optic neuropathy must be suspected when visual disturbances appear in patients submitted to radiotherapy for sellar or skull base pathologies. Contrast-enhanced MR is the examination of choice because it will delineate the radiation-induced lesion and rule out compression of the optic nerves or optic chiasm by the tumoral pathology. The radionecrotic lesion at MR is characterized by segmental swelling with gadolinium enhancement of the visual pathways. Two patients with rapid visual loss about one year after radiotherapy are described. Corticoids and hyperbaric oxygen therapy may be useful in the treatment. The severity of this complication focuses on a strict use of radiotherapy for benign lesions of the sellar and parasellar region.
The Role of the Nitric Oxide Pathway by Angiographic Demonstration of the Acute Phase of Arterial Spasm. An Experimental Study
Authors: Dogulu F. , Ilgit E. , Kurt G. , Kardeş Ö. , Baykaner M. Kemali , Ercan Z. Sevim
Published: April 2015

The present study examined the benefits of computerized quantitation methods for analysis of digital angiograms to quantify vasospasm. Methods currently used to quantify vasospasm in such experimental settings have several shortcomings. The present method provides quantitative data that none of the others provided. An endothelin-1 (ET-1) induced vasospasm model of the rabbit basilar artery was employed for the study. L-nitro arginine methyl ester (L-NAME) and dexamethasone were applied intra-arterially. Basilar artery diameters were measured by angiography using special software. L-NAME and dexamethasone inhibited the vasospasm caused by ET-1 that was quantified by computerized quantitation methods for analysis of digital angiograms. Computerized quantitation for analysis of digital angiograms is an accurate technique for the measurement of vasospasm. The non-selective nitric oxide synthases (NOS) inhibitor, L-NAME, inhibits the vasoconstriction induced by ET-1 as does the selective immunological NOS (iNOS) inhibitor, dexamethasone, in the proposed doses.
Cerebral Myxomatous Angiopathy. Imaging Features
Authors: Sonwalkar H.A. , Gupta A.K. , Varma D. Ravi , Purkayastha S. , Bodhey N. , Kesavadas C.
Published: April 2015

Strokes due to embolization from a cardiac myxoma are rare. Myxomatous cerebral emboli can cause occlusion of intracranial vessels or oncotic aneurysm formation. We describe a case of cardiac myxoma presenting with stroke having bilateral cerebral infarct and oncotic aneurysm formation. Myxomatous emboli have characteristic CT, MR and angiography findings, which are well seen in this case. The pathogenesis, imaging features, clinical presentation and natural history are discussed.
Radiation-Induced Vasculopathy: 3 Tesla MR Findings
Authors: Bacci A. , Ricci R. , Ahmed H. , Maye Sh. , Spagnoli M. , Agati R. , Leonardi M.
Published: April 2015

We present the MRI findings of delayed brain damage in a patient who underwent radiotherapy after resection of an oligo-astrocytoma. The lesions appeared years later within brain tissue that was included in radiation fields. High-field 3 Tesla MR investigation gave us the possibility to appreciate the different aspects of the vasculopathy induced by irradiation. A literature review allowed us to hypothesize the correlations between imaging and pathological findings.
Description and Clinical Signs and Symptoms of the Main Forms of Simple Craniosynostosis
Authors: Toldo I. , Drigo P.
Published: April 2015

Craniosynostosis, a skull growth disorder due to premature fusion of one or more sutures, is a common clinical problem requiring the attention of many specialists. In simple craniosynostosis (stenosis of a single suture) symptoms are usually mild: signs of intracranial hypertension, mental deficiency, visual or hearing problema are rare, whereas learning disorders or aesthetic and psychological problema are more common. Considering the data in the literature, we analyze the clinical presentation of the main forms of simple craniosynostosis (scaphocephaly, trigonocephaly, brachycephaly, plagiocephaly), their assessment, when measuring intracranial pressure can be useful and whether surgery affects late cognitive outcome.
Assessing Treatment Effects on Axonal Loss - Evidence from MRI Monitored Clinical Trials
Authors: Barkhof Frederik
Published: April 2015

Magnetic resonance imaging (MRI) is a collection of very sensitive and versatile techniques for detecting multiple sclerosis (MS) related damage in the central nervous system. Each technique is characterised by a particular combination of sensitivity, tissue and pathological specificity, and technical requirements that enable diverse aspects of MS to be explored.

MRI techniques also offer the possibility of quantitatively assessing the effects of therapeutic interventions, and to correlate these effects to clinical outcomes. Of special interest are newer MR techniques that correlate more strongly with disability than gadolinium-enhancement and T2 lesion load, and this review focuses on T1 hypointense lesions, MR spectroscopy, and brain atrophy as surrogate markers of axonal loss, and their application in randomised clinical trials.

Several disease-modifying therapies appear to have differential effects on inflammation, demyelination and axonal loss as judged by MRI, illustrating the unique capability of MRI to interrogate the pathophysiology of MS. At the same time it illustrates the difficulties in understanding the mechanisms leading to axonal loss and persistent clinical deficit.
Fusion of CT and MR 3D Models in Patients with Brain Tumours
Authors: Tsitouridis I. , Tezapsidis G. , Manolitsas A. , Goutsaridou F. , Papapostolou P. , Chondromatidou S. , Emmanouilidou M. , Tarazi L. , Papastergiou C.
Published: April 2015

We describe the process we use fuse CT and MRI images in patients with brain tumours and evaluate the utility of the fused 3D models. We scanned 11 patients with various brain tumours using both CT and MRI. CT and MR images were registered using an automatic algorithm. The images from CT were segmented and three dimensional models of the bone structures were produced. The images from MRI were segmented and three dimensional models of brain only and tumour only were produced. The three dimensional models were fused into one model which included bone structures from CT and brain and tumor from MRI. The registration and fusion of 3D models was completed successfully. in ten patients. Registration was unsuccessful in one patient due to movement artifacts in MR images. The fused 3D models were better at depicting the relationship between bone, brain and lesion than conventional display of different imaging modalities alone. This information can be used in daily clinical practice such as radiotherapy treatment planning or surgery or in basic clinical research.
Uncommon Variations and Anomalies of Craniocervical Arteries
Authors: Purkayastha S. , Gupta A.K. , Kapilamoorthy T.R. , Kesavadas C. , Thomas B. , Krishnamoorthy T. , Bodhey N.K.
Published: April 2015

Anomalies of craniocervical arteries are of medical and surgical importance. These are more detected after the widespread introduction of cranial angiography and more use of neurointerventional procedures. Here we describe the uncommon variations of craniocervical arteries.
Acute Encephalopathy Due to Plasticizer Intoxication: MRI Findings of Two Cases and Review of the Literature
Authors: Iseri P. , Akansel G. , Efendi Husnu , Budak F.
Published: April 2015

Polyvinyl chloride and plasticizer intoxication have a degenerative effect on the cerebral white matter characterized by bilateral, confluent lesions that reflect diffuse demyelination. We report similar clinical and neuroimaging manifestations in two patients with inhalation of these substances. MRI findings described here may be helpful in the diagnosis of future cases of suspected chloroparaffin poisoning.
Simultaneous Multiple Spontaneous Intracerebral Hemorrhages
Authors: Hsieh Cheng-Ta , Tsai Wen-Chiuan , Tsai Dueng-Han , Chiang Yung-Hsiao , Ju Da-Tong
Published: April 2015

The simultaneous occurrence of multiple intracerebral hemorrhages in different arterial territories of the brain is an uncommon clinical event. Hypertension is the most common risk factor in these cases, but the mechanism is not clear. Here, we present the case of a 68-year-old man with multiple simultaneous intracerebral hemorrhages over the thalamus and cerebellum. This is a rare case in the literature.
Focal Lesion in Splenium of Corpus Callosum on FLAIR MRI: Common Findings in Aged Patients
Authors: Guo G. , Wu R. , ter Brugge K. , Mikulis D.J.
Published: April 2015

Focal high signal intensity in the splenium of the corpus callosum on fluid-attenuated inversion-recovery (FLAIR) images is generally considered an abnormal MR finding. The aim of this study was to determine the frequency of this finding in elderly patients and review the differentiation from other diseases with the similar findings. FLAIR images of 132 patients with suspect CNS disease were retrospectively reviewed. The changes in the splenium of corpus callosum, deep white matter lesions, periventricular matter lesions, infarcts, atrophy and age were analyzed, as well as history. Among the initial 132 patients, focal high signal intensity in the splenium was associated with aging, white matter changes, atrophy, and cognitive disorders. Focal high signal intensity in the splenium of the corpus callosum on FLAIR image is a common finding in elderly patients, especially in aged patients with cognitive disorders. The pathologic alterations were commonly described by the term of “leukoaraiosis”. Knowledge of this finding and differentiation from other lesions focusing on the splenium of corpus callosum may help avoid unnecessary invasive diagnostic and therapeutic intervention.
Thrombotic Thrombocytopenic Purpura with Reversible Neurological Features: Brain Diffusion MRI with ADC Map, SPECT and EEG Findings
Authors: Yerdelen D. , Göksel B.K. , Yildirim T. , Karataş M. , Karaca S. , Reyhan M. , Özdoğu H.
Published: April 2015

Although nervous system involvement is common in thrombotic thrombocytopenic purpura ( TTP), abnormalities on computerized tomography, magnetic resonance imaging and electroencephalography are not encountered so frequently and if present, these abnormalities are often reversible. We describe a 39-year-old woman with recurring transient focal neurological findings found to have laboratory findings consistent with TTP. In cerebral diffusion weighted images ( DWI), diffuse cortical hyperintensity was noted in right frontal lobe, but the ADC (apparent diffusion coefficient) map was normal. Electroencephalography demonstrated lateralized slowing and repeated DWI showed diffuse cortical hyperintensity in the right hemisphere. SPECT showed luxury perfusion in the right hemisphere areas. The patient's condition resolved with plasmapheresis. Our patient illustrates that diffuse hemispheric involvement can be seen in DWI and EEG, and SPECT may show luxury perfusion after resolution of neurological findings in TTP cases. To our knowledge, this is the first TTP case in which the ADC map was normal.
The Prime Objective of Radiosurgery in Acoustic Neurinomas
Authors: Valentino V. , Benassi M. , Strigari L.
Published: April 2015

The central question of stereotaxic radiosurgery in acoustic neurinomas is how to pinpoint its main objective: is it a better alternative to neurosurgery or an option when surgery is unfeasible? This study is a continuation of the article published in 1995 in Acta Neurochirurgica, but benefits from greater experience, more complete analysis and longer supervision of results. The conclusions that can be drawn to date from our own findings and from others in the literature are the following: radiosurgery can be used not only to prevent neurinoma growth and at the same time to preserve the patient's neurological conditions without the risk of complications, but it can also be counted on to provide a cure. However, radiosurgery as an excising device is more insidious than the microsurgical scalpel, since the narrow beam of radiation, directed to a limited target without opening the skull, is invisible. The expression coined by Lars Leksell regarded precisely the innovation he himself conceived in the ‘closed skull operation’, with reference to its use in cases of acoustic neurinoma as an alternative to traditional surgery. Hence, whatever technique or instruments are involved, it is always a question of interventional neuroradiology or minimally invasive neurosurgery.
Giant Intracranial Chordoma: Neuroradiological and Radiotherapeutic Aspects
Authors: Conforti R. , Taglialatela G. , Scuotto A. , D'Agostino V. , Cirillo M. , Cirillo L. , Barone A. , Giordano A. , Parlato C. , Moraci A. , Cirillo S.
Published: April 2015

We describe a rare case of giant intracranial chordoma, emphasizing the patient's long survival and his excellent response to radiotherapy that led to a progressive regression of neurological symptomatology up to disappearance, in the absence of cerebral white matter damages.
Management of Spinal Dural Arteriovenous Fistulae with Emphasis on an Endovascular Approach
Authors: Guimaraens L. , Casasco A. , Cuellar H. , Sola T. , Vivas E. , Theron J. , Soler L.
Published: April 2015

Spinal arteriovenous shunts are rare and present at a rate of approximately 1:10 with cerebral arteriovenous shunts. Spinal dural arteriovenous fistulas (SDAVF) are the most common type of spinal vascular malformation in the adult and account for about 60% of all, with a marked male predominance (5:1). Endovascular treatment has gained force as the treatment of choice in recent years. We reviewed the patients sent to our service at Clinica del Rosario in Madrid and Hospital General de Cataluña in Barcelona between January 1991 and December 2005 with a diagnosis of SDAVF made clinically or by imaging for possible endovascular treatment. Location, presenting symptoms, and clinical outcome according to treatment were analyzed. A total of 104 patients were diagnosed and treated for a SDAVF, 85 were men and 19 women aged between 23 and 79 years (average 58). Seventy-six were treated with embolization alone (73%), 21 with a combination of endovascular therapy and surgery (20.1%) and seven patients had surgery alone (6.7%). Of the embolization group, 62 patients were cured (81.5%), 11 improved (14.4%) and three (3.9%) worsened. Of the group with combined therapy, 13 (61.9%) were cured, five (23.8%) improved and three (14.2%) worsened. Among the surgery group, four (57.2%) were cured and three (42.8%) worsened. Endovascular approach with liquid adhesive is gaining more acceptance as the treatment of choice for SDAVF if the conditions allow a super selective catheterization of the shunt. These patients benefit most when diagnosis is made early in the course of the pathology and have a better chance of a complete remission of symptoms.
Spontaneous Regression of Intracranial Arteriovenous Malformations
Authors: Pumar J.M. , Castiñeira J.A. , Vazquez F. , Blanco M. , Romero G. , Baleato S. , Ruibal C. , Lazaro V.
Published: April 2015

Spontaneous and complete regression of cerebral arteriovenous malformations has rarely been reported in the literature. We describe two new cases with a literature review.