Editor’s Choices
Placement of Covered Stents for the Treatment of Direct Carotid Cavernous Fistulas • C. Wang, X. Xie, C. You, C. Zhang, M. Cheng, M. He, H. Sun, and B. Mao
Endovascular treatment of direct carotid cavernous fistulas has been done mostly with balloons (outside of the United States) and coils. With the introduction of flexible covered stents, deployment in vessel curvatures has become possible. In this article, the authors review their experience in the treatment of 10 direct carotid cavernous fistulas with covered stents and provide follow-up (mean, 18 months). Treatments were successful in 9 patients; endoleaks were observed immediately in 3 instances and treated in the same setting in 2, while the third patient needed balloons to finalize treatment. Follow-up showed good results in all. This small series provides preliminary evidence that treating direct carotid cavernous fistulas in this way is promising.
Percutaneous Cement Augmentations of Malignant Lesions of the Sacrum and Pelvis • B.A. Georgy
Percutaneous cement injection has been used to treat sacral fractures. In a variation on this theme, the author describes his experience using this treatment for malignant lesions of the sacrum and pelvis. Under CT guidance, he injected cement into metastases found in the aforementioned bones in 12 patients. At 4-week follow-up, all but 1 patient reported significantly decreased pain using a semi-quantitative scale and no further interventions were deemed necessary. He concludes that this treatment is feasible, safe, and provides at least short-term relief.
Intracranial Aneurysms in Childhood: 27-Year Single-Institution Experience • S.W. Hetts, J. Narvid, N. Sanai, M.T. Lawton, N. Gupta, H.J. Fullerton, C.F. Dowd, R.T. Higashida, and V.V. Halbach
Unlike what has been traditionally taught, aneurysms are not congenital and are very rare in children. In this retrospective series, the authors reviewed their experience of 27 years in a single institution. They looked at the imaging and clinical findings in patients younger than 19 years of age and found 77 patients with 103 aneurysms. Treatment-related mortality was 1.3% and morbidity included infarction (8%) and new-onset seizures (4%). Six patients developed new aneurysms. Aneurysms were more common in girls and predominantly had a saccular morphology. The authors concluded that in experienced centers, pediatric intracranial aneurysms may be treated with acceptable risk via an endovascular approach.
Fellows’ Journal Club
Thalamic Involvement and Its Impact on Clinical Disability in Patients with Multiple Sclerosis: A Diffusion Tensor Imaging Study at 3T • F. Tovar-Moll, I.E. Evangelou, A.W. Chiu, N.D. Richert, J.L. Ostuni, J.M. Ohayon, S. Auh, M. Ehrmantraut, S.L. Talagala, H.F. McFarland, and F. Bagnato
Involvement of gray matter structures is being increasingly recognized as an important component of multiple sclerosis and related to clinical disabilities. This type of involvement happens in the cortex most prominently. In this prospective, controlled study, the authors used diffusion tensor imaging to evaluate the normal-appearing thalami in MS patients and control subjects. MS patients showed higher fractional anisotropy values that correlated with lesser auditory tasks. Also, DTI results correlated with scores in the Expanded Disability Status Scale. The authors conclude that DTI scores correlate with those obtained from standard MR imaging disease measures and thus the integrity of the thalami, as evaluated with DTI, is a promising marker of disease.
Are C1–2 Punctures for Routine Cervical Myelography below the Standard of Care? • D.M. Yousem and S.K. Gujar
Although fellows seem to be frightened by C1-2 punctures, I always insist they need to perform them during their training. In this study, the authors sent questionnaires regarding the use of this technique to 120 neuroradiology training program directors. Of these, 85 responded as follows: 14% reported not having done any in the previous 12 months, 38% performed 6 or less, 79% preferred doing a lumbar puncture for cervical myelograms whereas 6% favored the C1-2 approach. In all institutions, at least one person with experience with this approach was available and 73% taught their fellows this procedure. The authors concluded that C1-2 punctures are within the standard of care in the United States.
Hemorrhage in Posterior Reversible Encephalopathy Syndrome: Imaging and Clinical Features • H.M. Hefzy, W.S. Bartynski, J.F. Boardman, and D. Lacomis
Posterior reversible encephalopathy syndrome is an entity familiar to all neuroradiologists but its hemorrhagic variant is relatively uncommon. These authors from the University of Pittsburgh have significant experience with PRES and retrospectively analyzed studies in 151 patients. They found 23 instances of hemorrhage at toxicity and performed clinical correlations. The overall incidence of hemorrhagic PRES was 15% and it was more common after allogeneic bone marrow transplantation than solid organ transplants. While blood pressure played no significant role, hemorrhage was more common in anticoagulated patients. Hemorrhages were minute, sulcal SAH or hematomas.
