Aggressive cavernous sinus dural arteriovenous fistula: Angioarchitecture analysis and embolization by various approaches.

Background: Most cavernous sinus dural arteriovenous fistulas (CSDAVFs) present with benign neuro-ophthalmic symptoms. CSDAVFs manifesting with aggressive neurologic symptoms are rare. The purpose of this study was to analyze the different angioarchitectures of aggressive CSDAVFs and to report our experiences of embolization.

Transvenous embolization of cavernous sinus dural arteriovenous fistula via angiographic occlusive inferior petrous sinus.

Background: Trans-inferior petrous sinus (IPS) coil embolization is an efficient and safe method to manage cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some CSDAVFs may be associated with angiographic occlusive IPS making access difficult. The purpose of this study was to report our experience of transvenous embolization of the CSDAVF via angiographic occlusive IPS.

Anatomic Variation of Facial Vein in Carotid-Cavernous Fistula and Trans-Facial Vein Embolization.

Objective: Trans-facial vein (FV) embolization via the internal jugular vein is an alternative approach to embolization of carotid cavernous fistulas (CCFs). The purpose of this study is to report the anatomic variation of FVs and our experience of trans-FV embolization of CCFs.

Methods: Over 6 years, 26 patients (12 men and 14 women; age range 27-72 years old) with CCFs underwent trans-FV embolization because of anterior drainage of fistulas.

Update of embolization of intracranial dural arteriovenous fistula.

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous communications within the dura locating near a major venous sinus and are supplied by pachymeningeal arteries. DAVFs represent 10-15% of all intracranial arteriovenous malformations. The natural history and clinical manifestations are determined by location of the DAVFs and their angioarchitecture.

Impact of carotid stenting in dizzy patients with carotid stenosis.

Background: Little is known about the impact of severe carotid stenosis on health-related quality of life (HRQoL). The aim of this study was to assess the effects of carotid stenting (CAS) on HRQoL in dizzy patients with carotid stenosis.

Methods: Patients with symptomatic (≥60%) or asymptomatic (≥80%) severe carotid stenosis and who complained of dizziness and received CAS were recruited.

CT of globe rupture: analysis and frequency of findings.

Objective: The objective of our study was to evaluate the CT characteristics of globe rupture.

Materials And Methods: The medical records of patients seen in the emergency department with blunt, penetrating, or explosive orbit injury were retrospectively reviewed. A total of 75 patients (76 injured globes) were included (56 males and 19 females; average age, 45.

Fistula component of cerebral arteriovenous malformations: morphologic change after stereotactic radiosurgery and outcome of embolisation.

Background: The angioarchitecture of arteriovenous fistulas (AVFs) of cerebral arteriovenous malformation (CAVM) after stereotactic radiosurgery (SRS) remain unclear. The purpose of this study is to report the angiographic change of AVF components of CAVMs after SRS and outcomes of endovascular embolisation.

Methods: From 2002 to 2012, a total of 523 CAVMs had been treated primarily by SRS with more than 3-year latency.

Reverse waffle cone technique in management of stent dislodgement into intracranial aneurysms.

Stent-assisted coil embolization (SACE) is a common method to manage intracranial wide-neck aneurysm. Using this technique, a stent must be successfully deployed into the parent artery to cross the aneurysm neck. We describe the reverse waffle cone technique in management of intra-procedural stent dislodgement during SACE of internal carotid artery (ICA) wide-neck aneurysms.

Toward the era of a one-stop imaging service using an angiography suite for neurovascular disorders.

Transportation of patients requiring multiple diagnostic and imaging-guided therapeutic modalities is unavoidable in current radiological practice. This clinical scenario causes time delays and increased risk in the management of stroke and other neurovascular emergencies. Since the emergence of flat-detector technology in imaging practice in recent decades, studies have proven that flat-detector X-ray angiography in conjunction with contrast medium injection and specialized reconstruction algorithms can provide not only high-quality and high-resolution CT-like images but also functional information.

Fistula components of brain arteriovenous malformations: angioarchitecture analysis and embolization prior to gamma-knife surgery.

Background: Gamma-knife surgery (GKS) is ineffective for high-flow arteriovenous fistula (AVF). The purpose of this study was to present the angioarchitecture of the AVF of brain arteriovenous malformation (BAVM) and report our experience of endovascular embolization of AVF component prior to GKS.

Methods: In the past 10 years, a total of 523 BAVMs had been treated primarily by GKS.

Unusual giant intraspinal teratoma in an infant.

There are few cases of giant pediatric intraspinal teratoma. We report a case of a 4-month-old female baby with giant intraspinal teratoma. Magnetic resonance imaging (MRI) of the spine revealed a large intradural tumor from the C7 to S2 level, with solid, cystic, and fatty components.

How far can the radiation dose be lowered in head CT with iterative reconstruction? Analysis of imaging quality and diagnostic accuracy.

Objective: To evaluate the imaging quality of head CT at lowered radiation dose by combining filtered back projection (FBP) and iterative reconstruction (IR) algorithms.

Methods: Experimental group A (n = 66) underwent CT with 43 % tube current reduction, and group B (n = 58) received an equivalent reduced dose by lowering the tube voltage. An age- and sex-matched control group (n = 72) receiving the conventional radiation dose was retrospectively collected.

Improvements in the quantitative assessment of cerebral blood volume and flow with the removal of vessel voxels from MR perfusion images.

Objective: To improve the quantitative assessment of cerebral blood volume (CBV) and flow (CBF) in the brain voxels from MR perfusion images.

Materials And Methods: Normal brain parenchyma was automatically segmented with the time-to-peak criteria after cerebrospinal fluid removal and preliminary vessel voxel removal. Two scaling factors were calculated by comparing the relative CBV and CBF of the segmented normal brain parenchyma with the absolute values in the literature.

Transarterial detachable coil embolization of direct carotid-cavernous fistula: immediate and long-term outcomes.

Background: Transarterial embolization is a standard method for management of direct carotid-cavernous fistula (DCCF). The purpose of this study was to report our experiences, and immediate and long-term outcomes of endovascular embolization of DCCFs by using detachable coils (DCs).

Methods: Over 8 years, 24 patients with 25 DCCFs underwent endovascular DC embolization.

Change in brain perfusion after extracranial-intracranial bypass surgery detected using the mean transit time of computed tomography perfusion.

Background: Cerebral perfusion can be evaluated using a computed tomography (CT) scan by intravenous bolus injection of contrast media. The purpose of this study was to investigate the value of CT perfusion (CTP) in follow-up of extracranial-intracranial (EC-IC) bypass surgery.

Methods: We retrospectively reviewed pre- and postoperative CTP studies in 14 patients who received EC-IC bypass surgery because of cerebral arterial occlusion or stenosis.

Validation and absolute quantification of MR perfusion compared with CT perfusion in patients with unilateral cerebral arterial stenosis.

Objective: The aim of the study was to assess absolute quantification of dynamic susceptibility contrast-enhanced magnetic resonance perfusion (MRP) comparing with computed tomography perfusion (CTP) in patients with unilateral stenosis.

Materials And Methods: We retrospectively post-processed MRP in 20 patients with unilateral occlusion or stenosis of >79% at the internal carotid artery or the middle cerebral artery (MCA). Absolute quantification of MRP was performed after applying the following techniques: cerebrospinal fluid removal, vessel removal, and automatic segmentation of brain to calculate the scaling factors to convert relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values to absolute values.

Stent-assisted coil embolization of intracranial aneurysms: a single center experience.

Background: Endovascular detachable coil embolization has become an important method in the management of intracranial aneurysms. However, coil embolization alone may fail to treat some wide-neck aneurysms. Herein, we report our experience with and outcome of stent-assisted coil embolization (SACE) of intracranial aneurysms.

Transorbital direct puncture of the posterior cavernous sinus through the internal carotid artery for embolization of isolated cavernous sinus dural arteriovenous fistula.

Background: Most cavernous sinus dural arteriovenous fistulas (CSDAVFs) present with benign ocular symptoms; isolated CSDAVFs with aggressive behavior are extremely rare. The treatment goal is to occlude the fistula totally. However, transarterial or venous access may not be possible because of complex angioarchitecture.

Selection of arterial input function for postprocessing of cerebral ct perfusion in chronic unilateral high-grade stenosis or occlusion of the carotid or middle cerebral artery.

Rationale And Objectives: We evaluated the effect of the arterial input function (AIF) on computed tomography perfusion (CTP) in patients with unilateral high-grade stenosis or occlusion in the carotid artery or middle cerebral artery without acute stroke.

Materials And Methods: CTP datasets were retrospectively postprocessed using the same venous output function and different AIF selections: the second segment of the anterior cerebral artery (A2 AIF), the second segment of the middle cerebral artery (MCA) on the lesion side (affected M2 AIF), and M2 on the contralateral side (nonaffected M2 AIF). We measured CTP values in the region of interest (ROI) in the bilateral MCA territory and evaluated the lesion-to-contralateral ratios.

Risk of post-vertebroplasty fracture in adjacent vertebral bodies appears correlated with the morphologic extent of bone cement.

Background: New fractures in adjacent vertebral bodies were found after percutaneous vertebroplasty. We evaluated the correlation between extent of polymethylmethacrylate cement and occurrence of post-vertebroplasty fractures in patients with osteoporosis.

Methods: Totally 162 adjacent vertebral bodies with no fracture at the time of vertebroplasty and the distribution of cement in corresponding treated vertebral bodies of 98 patients were included for the evaluation.

Distal marginal stenosis: a contributing factor in delayed carotid occlusion of a patient with carotid blowout syndrome treated with stent grafts.

Distal marginal stenosis is rarely reported to be a factor associated with poor long-term patency of patients of head and neck cancers with carotid blowout syndrome treated with stent grafts. We report a case of laryngeal cancer with rupture of the right common carotid artery. A self-expandable stent graft was deployed, but bleeding recurred.

Removal of CSF pixels on brain MR perfusion images using first several images and Otsu's thresholding technique.

Brain MR perfusion imaging is used to evaluate local perfusion in patients with cerebral vascular disease. Quantitative measurements on the hemodynamic parameters and volume of brain with abnormal perfusion provide an estimation of the severity of the brain perfusion defect. However, quantitative measurements of these focal cerebral hemodynamic parameters are limited by the presence of cerebrospinal fluid (CSF) pixels.

Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients: the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) study.

Background And Purpose: The safety and efficacy of alteplase for ischemic stroke has not been examined in Chinese patients. We assessed the safety and efficacy of alteplase for acute ischemic stroke in daily clinical practice in Taiwan.

Methods: A prospective, multicenter, observational study was conducted in Taiwan from December 2004 to July 2008.

Multiple intracranial carotid injuries: pitfalls in diagnosis by angiography and principles of endovascular treatment.

Background: Simultaneous multiple intracranial carotid injuries (ICIs) after head trauma are rarely referred for treatment and are often times fatal. The purpose of this study was to describe the potential angiographic pitfalls in diagnosis of multiple ICIs and to report the principles of endovascular management in 15 patients with 34 ICIs.

Methods: A 12-year study of the 15 patients (8 men and 7 women) with 34 ICIs was completed, and patients were managed by endovascular treatment.

Combined transarterial, transvenous, and direct puncture of the cavernous sinus to cure a traumatic carotid cavernous fistula.

Direct carotid cavernous fistulas (CCF) are generally well managed by simple endovascular treatment. We report an 8-year-old boy who required subsequent direct puncture of the cavernous sinus to completely obliterate the residual fistula after both transarterial and transvenous embolization had been performed. He presented with a mild right frontal headache, congestion of the right conjunctiva, blurred vision, and photophobia.