Perfusion MRI in Cerebral Venous and Sinus Thrombosis.

Background And Purpose: Cerebral venous and sinus thrombosis (CVST) leads to perfusion abnormality in the brain. Our aim was to assess perfusion abnormalities in the center and periphery of the parenchymal lesion in CVST patients and correlate with the clinical outcome.

Materials And Methods: Dynamic susceptibility contrast (DSC) perfusion imaging was performed in patients with CVST.

Management of scalp arteriovenous malformations: a rising trend towards percutaneous direct puncture embolization technique-our experience.

Background: Scalp arteriovenous malformations (AVMs), or cirsoid aneurysms of the scalp, usually present with troublesome symptoms and cosmetic disfigurement. Endovascular/percutaneous embolization has evolved as a sole treatment method or adjunct to surgical excision in the management of scalp AVMs with an excellent outcome.

Purpose: To discuss minimally invasive techniques for treating scalp AVMs as well as to highlight the role of embolization before surgery.

Blood in the Brain on Susceptibility-Weighted Imaging.

Intraparenchymal brain hemorrhage is not uncommon and results from a wide variety of causes ranging from trauma to tumor. Many a time, it is not possible to determine the exact cause of non-traumatic hemorrhage on conventional magnetic resonance imaging (MRI). Susceptibility-weighted imaging (SWI) is a high-resolution (3D) gradient-echo sequence.

Endovascular management of pulmonary arteriovenous malformations presenting as multiple brain abscesses.

Pulmonary arteriovenous malformations (PAVMs) are rare vascular lesions characterised by abnormal connections between the pulmonary artery and vein bypassing the pulmonary capillary bed and causing right-to-left shunt. Paradoxical embolism is known to occur in these cases, leading to inoculation of septic focus in the systemic circulation. We report a case of multiple PAVMs who presented clinically with seizures and altered sensorium.

Balloon-Assisted Coiling of Intracranial Aneurysms: Technical Details and Evaluation of Local Complications.

Background: Wide-neck intracranial aneurysms need additional devices like balloons or stent for management. Balloon-assisted coiling has evolved both with interventionalist experience and device modifications.

Objective: We discussed our experience, evolution, and complications with this novel technique.

Paraclinoid Segment Aneurysms of the Internal Carotid Artery: Surgical Clipping.

Background: Paraclinoid segment aneurysms arise from the internal carotid artery (ICA) between the distal dural ring and the origin of the posterior communicating (PComm) artery.

Objective: This pictorial study presents videos showing clipping of paraclinoid segment aneurysms.

Materials And Methods: The various subtypes of these aneurysms, the nuances in the technique of clinoidectomy, and methods of proximal control are presented.

Repeated aspiration and sclerotherapy to manage recurrent spinal epidermoid cyst.

Spinal epidermoid cysts are rare lesions and epidermoid cyst in intramedullary location is even rarer. Surgical excision is the mainstay of treatment; however, in cases of recurrence, repeat surgery becomes quite difficult. Treatment of recurrent intramedullary epidermoid cyst by surgery alone is a challenge.

Getting More Out of Follow-up Three-Dimensional Time-of-Flight Magnetic Resonance Angiography in Endovascularly Treated Intracranial Aneurysms.

Background: We retrospectively re-evaluated follow-up three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) in patients with aneurysms treated with coiling at our Institute.

Aims: To document the type and frequency of postcoiling residue patterns as seen on follow-up MRA and to document their evolution with time where a further follow-up MRA was available. To assess the implications of the location of the aneurysm on residue and recurrence.

Complete resolution of long pedunculated thrombus of the proximal ascending aorta following conservative management: an interesting case.

We report a case of a 60-year-old woman who presented clinically with symptoms of acute embolic stroke. On workup with MRI, carotid Doppler and subsequent CT angiography, a long pedunculated mobile thrombus was seen with the base of the thrombus attached to the ascending aorta and the tip protruding into the left common carotid artery. She was advised urgent cardiovascular surgery consultation; however, she preferred medical management over surgery.

Endovascular Management of Direct Carotid-Cavernous Fistula: Evolution of Cost Effective Sandwich Technique.

 There is a direct fistulous connection between the cavernous segment of the internal carotid artery and cavernous sinus in cases of direct carotid-cavernous fistula (CCF). Endovascular embolization is the mainstay of management in this condition. This study is about the evolution of endovascular treatment methods and the development of a cost-effective technique for embolization of direct CCF at a tertiary care center.

Selective renal segmental artery embolization for hydronephrotic upper renal moiety: simple alternative to standard surgical resection.

Duplex kidney with an ectopic upper moiety ureter usually presents with urinary incontinence in young females. If the ectopic ureter belongs to a non-functioning moiety, it is treated with surgical resection of the moiety. Renal artery embolization has been used in patients with a poorly functioning kidney for various indications.

Posterior Cerebral Artery Aneurysms: Parent Vessel Occlusion Being a Viable Option in the Era of Flowdivertors.

Background And Purpose: The purpose of this study is to evaluate posterior cerebral artery (PCA) aneurysms along with the efficacy, safety, procedural, and clinical outcome of the endovascular management of these aneurysms. We studied different techniques of endovascular treatment such as selective aneurysmal coiling, parent artery occlusion, and stent-assisted coiling in PCA aneurysms.

Methods: From 2010 to 2017, 11 patients (8 females, 3 males) harboring a PCA aneurysm were treated via an endovascular approach.

Endovascular biopsy in Takayasu arteritis.

Takayasu arteritis is a chronic inflammatory arteriopathy of the large vessels, mainly the aortic arch and its branches. The disease progression varies, ranging from a rapid progression to quiescence reached within 2 years. The activity of the disease is evaluated by biochemical markers, but at times, there is a discrepancy between the clinical picture and biochemical markers.

Detection and Evaluation of Intracranial Aneurysms in the Posterior Fossa by Multidetector Computed Tomography Angiography - Comparison with Digital Subtraction Angiography.

Introduction: Posterior fossa hemorrhages are not so frequent but as posterior cranial fossa space is narrow and has many vital structures, even a small amount of bleed can lead to compression of brain stem and serious consequences. Identification and planning management of cause of bleed requires angiogram. Digital subtraction angiography (DSA) being invasive modality but is gold standard, so noninvasive computed tomography angiography (CTA) is compared to detect cause of bleed in the posterior fossa in this study.

Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis.

Purpose: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis.

Materials And Methods: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.

Dynamic magnetic resonance imaging parameters for objective assessment of the magnitude of tethered cord syndrome in patients with spinal dysraphism.

Background: Dynamic magnetic resonance imaging (MRI)-based criteria for diagnosing magnitude of tethered cord syndrome (TCS) in occult spinal dysraphism are proposed.

Methods: In this prospective, case-control design study, MRI lumbosacral spine was performed in 51 subjects [pilot group (n = 10) without TCS (for defining radiological parameters), control group (n = 10) without TCS (for baseline assessment), and study group (n = 31) with spinal dysraphism (thick filum terminale [n = 12], lumbar/lumbosacral meningomyelocoele [n = 6], and lipomyelomeningocoele [n = 13])]. The parameters compared in control and study groups included oscillatory frequency (OF), difference in ratio, in supine/prone position, of distance between posterior margin of vertebral body and anterior margin of spinal cord (oscillatory distance [OD]), with canal diameter, at the level of conus as well as superior border of contiguous two vertebrae above that level; delta bending angle (ΔBA), difference, in supine/prone position, of angle between longitudinal axis of conus and that of lower spinal cord; and sagittal and axial root angles, subtended between exiting ventral nerve roots and longitudinal axis of cord.

Papilledema revisiting after sinus angioplasty of chronic cerebral venous sinus thrombosis.

This case series aimed to review the significance of revisiting papilledema after successful cerebral venous sinus thrombosis (CVST) management with sinus angioplasty. Four patients presented with blurring and transient obscuration of vision with papilledema, headache, tinnitus, and vomiting. On magnetic resonance venography and digital subtraction angiography, chronic transverse sinus thrombosis was diagnosed for which patients underwent endovascular intervention (stenting).

Three-dimensional visualization of intracranial tumors with cortical surface and vasculature from routine MR sequences.

The simultaneous three-dimensional (3D) visualization of intracranial tumors, brain structures, skull, and vessels is desired by neurosurgeons to create a clear mental picture of the anatomical orientation of the surgical field prior to the surgical intervention. Different anatomical and pathological components are usually visualized separately on different magnetic resonance (MR) sequences; however, during surgery, they are tackled simultaneously. Another problem is that most present day MR workstations enable review of two-dimensional (2D) slices only with limited postprocessing options.