Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial.

Background: Chronic rhinosinusitis (CRS) affects up to 16% of the population. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. The value of resecting the middle turbinate to optimize surgical outcomes has been hypothesized but remains controversial and unproven.

Improved transoral surgical tool design by CT measurements of the oral cavity and pharynx.

The majority of head and neck cancers arise from the oral cavity and oropharynx. Many of these lesions will be amenable to surgical resection using transoral approaches including transoral robotic surgery (TORS). To develop and control TORS tools, precise dimensions of the oral cavity and pharynx are desirable.

Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma.

Background: Oral cavity squamous cell carcinoma (SCC) represents the most common SCC affecting the head and neck region. Long-term survival of patients with oral cavity SCC is adversely affected by lymph node metastasis and further decreased by the presence of lymph node extracapsular spread (ECS).

Methods: Using a case-control design, preoperative CT scans from patients with oral cavity SCC and metastatic lymphadenopathy were evaluated by 2 independent neuroradiologists, blinded to the study, for a number of radiologic parameters, including central node necrosis.

Impact of neuroradiologist second opinion on staging and management of head and neck cancer.

Objective: Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management.

The ICV sign as a marker of increased cerebral blood transit time.

Objective/background: We describe the internal cerebral vein (ICV) sign, which is a hypo-opacification of the ICV on computed tomogram angiography (CTA) as a new marker of increased cerebral blood transit-time in ipsilateral internal carotid artery occlusions (ICAO).

Methods: A retrospective analysis of 153 patients with acute unilateral M1 middle cerebral artery (MCA) occlusions ± ICAOs was performed. The degree of contrast opacification of the ICV on the ipsilesional side was compared to that of the unaffected side.

Combined full-dose IV and endovascular thrombolysis in acute ischaemic stroke.

Background: There is an increasing trend to treating proximal vessel occlusions with intravenous-inter-arterial (IV-IA) thrombolysis. The best dose of IV tissue plasminogen activator (tPA) remains undetermined. We compared the combination of full-dose IV recombinant tissue plasminogen activator (rtPA) and IA thrombolytic therapy to IA therapy.

Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion : a case report and review of literature.

Aneurysms of the anterior choroidal artery are uncommon and account for only 2-5% of all intracranial aneurysms. Distal anterior choroidal artery aneurysms are rare and the pathogenesis of this aneurysm may be different from typical proximal ones. We describe an unusual case of ruptured de novo distal anterior choroidal artery aneurysm in a 55 year-old man who had previously undergone endovascular proximal occlusion for a fusiform aneurysm of the ipsilateral posterior cerebral artery (PCA).

Isolation of novel Bacillus species showing high mosquitocidal activity against several mosquito species.

Two novel mosquitocidal bacteria, VB17 and VB24, identified as new Bacillus species were isolated from dead mosquito larvae obtained in Florida aquatic habitats. Gas chromatographic analysis of fatty acid methyl esters (GC-FAME) and 16S rRNA sequencing indicated that VB24 is closely related to Bacillus sphaericus whereas VB17 does not have a close relationship with either Bacillus thuringiensis or B. sphaericus.

Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke.

Introduction: Quicker recanalization results in better clinical outcomes in patients with acute ischemic strokes. We describe our experience with the use of a self-expanding, fully retrievable stent in acute intracranial occlusions.

Methods: Patients who underwent intra-arterial procedures with a self-expanding, fully retrievable stent for acute ischemic strokes at our center in 2009 were included in this study.

Fusiform lenticulostriate artery aneurysm with subarachnoid hemorrhage: the role for superselective angiography in treatment planning.

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram.

Initial experience with the Penumbra Stroke System for recanalization of large vessel occlusions in acute ischemic stroke.

Introduction: The Penumbra system is a newly approved mechanical device for the treatment of acute stroke designed for better and faster recanalization. We describe our initial experience with the use of this device.

Methods: We studied 27 consecutive patients with acute ischemic strokes due to arterial occlusions presenting at our center from January to October 2009.

Extravasating contrast material on angiography following carotid angioplasty and stenting: not necessarily subarachnoid hemorrhage.

We describe a case of asymptomatic extravasation of iodinated contrast material into the sulci on digital subtraction angiography following carotid angioplasty and stenting resulting in sulcal hyperdensity on computed tomography (CT). We believe the mechanism for this observation is hyperperfusion injury and that in the absence of any associated clinical signs, it should not be considered alarming for subarachnoid hemorrhage.

Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score.

Background: In ischemic stroke, functional outcomes vary depending on site of intracranial occlusion. We tested the prognostic value of a semiquantitative computed tomography angiography-based clot burden score.

Methods: Clot burden score allots major anterior circulation arteries 10 points for presence of contrast opacification on computed tomography angiography.

Communicating hydrocephalus after endovascular coiling of unruptured aneurysms: report of 2 cases.

To the authors' knowledge, only 1 case of communicating hydrocephalus after endovascular coiling of unruptured brain aneurysms has been reported previously. Here, they report on 2 such cases of delayed communicating hydrocephalus after treatment with hydrogel-coated coils and offer the first histopathological evidence of foreign material, presumably related to the coils, as the cause of hydrocephalus.

MRI of ischemic stroke in canines: applications for monitoring intraarterial thrombolysis.

Purpose: To describe a canine embolic stroke model that is appropriate for endovascular procedure evaluations and develop local cerebral blood flow (CBF) maps to monitor the progression of stroke and thrombolysis. In the future, MR may displace X-ray imaging in some endovascular procedures, such as intraarterial (IA) thrombolysis for stroke therapy, due to increased monitoring capabilities. For MR to attain its full potential in endovascular therapy, the development of appropriate disease models and monitoring techniques is essential.

Assessment of brain aneurysms by using high-resolution magnetic resonance angiography after endovascular coil delivery.

Object: Digital subtraction (DS) angiography is the current gold standard of assessing intracranial aneurysms after coil placement. Magnetic resonance (MR) angiography offers a noninvasive, low-risk alternative, but its accuracy in delineating coil-treated aneurysms remains uncertain. The objective of this study, therefore, is to compare a high-resolution MR angiography protocol relative to DS angiography for the evaluation of coil-treated aneurysms.

Primary angiitis of the spinal cord presenting as a conus mass: long-term remission.

Background: Primary angiitis of the central nervous system (CNS) is a rare vasculitic disorder that typically involves the brain and, less frequently, the spinal cord without involvement of the blood vessels outside the CNS.

Case Description: We present a case of a 52-year-old woman who developed a conus syndrome linked to an enhancing mass of her lower thoracic spinal cord, lumbar cord, and conus. Spinal cord biopsy performed for diagnostic purposes in the setting of progressive neurological deficit confirmed angiitis of the spinal cord.

MR angiography compared to conventional selective angiography in acute stroke.

Background And Purpose: Accuracy of intracranial magnetic resonance angiography (MRA) and reliability of interpretation are not well established compared to conventional selective catheter angiography. The purpose of this study was to determine the accuracy of MRA in evaluation of intracranial vessels in acute stroke and transient ischemic attack (TIA) patients

Methods: Twenty-nine patients (seven females, 22 males; median age 53) with acute stroke or TIA were enrolled into the study. All patients underwent both MRA using a 3 T clinical magnet and conventional angiography within 48 hours.

Intra-arterial thrombolysis for retinal artery occlusion: the Calgary experience.

Introduction: Retinal artery occlusion represents a medical emergency with poor prognosis for visual recovery. Spontaneous improvement is estimated to occur in less than 15% of central retinal artery occlusion (CRAO) cases and conventional treatments have provided only limited benefit. Intra-arterial thrombolysis has been reported as a potentially efficacious and safe treatment.

Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging.

Background And Objectives: Controversy exists about the optimal imaging technique in acute stroke. It was hypothesised that CT is comparable with DWI, when both are read systematically using quantitative scoring.

Methods: Ischaemic stroke patients who had CT within six hours and DWI within seven hours of onset were included.

ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome.

Background And Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) is a grading system to assess ischemic changes on CT in acute ischemic stroke. CT angiography-source images (CTA-SI) predict final infarct volume. We examined whether the final infarct ASPECTS and clinical outcome were more related to acute CTA-SI ASPECTS than to the acute noncontrast CT (NCCT) ASPECTS.