Editor’s Choices
Microembolic Signal Monitoring after Coiling of Unruptured Cerebral Aneurysms: An Observational Analysis of 123 Cases • G.A. Schubert, C. Thomé, M. Seiz, C. Douville, and J. Eskridge
Thromboembolic complications occur during 5–60% of all aneurysm coiling procedures and 3–6% are clinically symptomatic. These authors utilized transcranial Doppler to detect microemboli after coiling and then correlated their presence with patient demographics, aneurysm size, type of procedure and complication, medication, and clinical outcome in 123 patients. Procedures involving larger aneurysms, stent assistance, and incomplete occlusions were associated with greater risk of microemboli and heparinization played an important role in prevention.
Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms • M. Abdihalim, S.H. Kim, A. Maud, M. F. K. Suri, N. Tariq, and A.I. Qureshi
After embolization, not uncommonly one sees coils protruding outside of the aneurysm into the lumen of the parent artery. What does this mean? The authors identified 256 patients with this finding from 3 different medical centers and set out to assess their short- and intermediate-term outcomes. They graded coil protrusions from a single loop projecting into less than half of the parent artery (grade 1) to those protruding into more than half (grade 3). Most protrusions in the series were grade 1. All patients were placed on aspirin and complications were not directly related to coil protrusions. The authors concluded that antiplatelet therapy is efficacious in preventing vessel thrombosis in this situation.
Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions • R.M. Ahmed, M. Wilkinson, G.D. Parker, M.J. Thurtell, J. Macdonald, P.J. McCluskey, R. Allan, V. Dunne, M. Hanlon, B.K. Owler, and G.M. Halmagyi
Current thinking is that transverse sinus stenosis with significant pressure gradient across the narrowing may play a role in pseudotumor cerebri and that treatment may improve symptoms. Here, the authors review their experience with 52 patients who were clinically followed for 2–8 months after stenting. During this time all pressure gradients improved and symptoms were abolished. Symptom relapse occurred in 6 patients and all showed sinus restenosis. At the end of the study period, 49 of 52 patients were cured of their headaches and the authors concluded that transverse sinus stenting is beneficial in this clinical setting.
Fellows’ Journal Club
Low-Dose Temporal Bone CT in Infants and Young Children: Effective Dose and Image Quality • C.B. Nauer, A. Rieke, C. Zubler, C. Candreia, A. Arnold, and P. Senn
If your institution is like ours, you must perform many temporal bone CT studies in children and worry about radiation exposure. These authors compared techniques using 80 kV/90–100 mAs (low dose) and 140kV/170 mAs (high dose) for temporal bone CT studies in children aged 5 years. Neuroradiologists and otologists evaluated 23 structures in those studies. Low-dose CT was given lower scores but these differences were only significant when otologists evaluated the studies. Thus, the image quality of low-dose CT was perceived as insufficient by our clinical colleagues.
Impact of Brain Tumor Location on Morbidity and Mortality: A Retrospective Functional MR Imaging Study • J.M. Wood, B. Kundu, A. Utter, T.A. Gallagher, J. Voss, V.A. Nair, J.S. Kuo, A.S. Field, C.H. Moritz, M.E. Meyerand, and V. Prabhakaran
These investigators assessed the relationship between the distance of tumor border to eloquent brain regions (motor and language) identified by fMRI and pre- and postoperative morbidity and mortality. Factors that affected patient motor and language presentation and outcomes were close proximity of tumor to functional areas and advanced age. Right-handedness affected only language deficits. Variables that influenced survival included tumor grade, location, and proximity to language and motor areas. These findings indicate that tumors may affect language and motor function differently, depending on tumor lesion to activation distance. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to preoperative neurosurgical planning.
Joubert Syndrome and Related Disorders: Spectrum of Neuroimaging Findings in 75 Patients • A. Poretti, T.A.G.M. Huisman, I. Scheer, and E. Boltshauser
In this nice Clinical Report, the authors review not only the classic features of Joubert syndrome (vermian hypoplasia and molar tooth sign) but also other lesser known features found in 75 patients. All showed vermian abnormalities and molar tooth sign and, in addition, the following findings were also quite common: enlarged posterior fossa, brain stem abnormalities, callosal dysgenesis with malrotation of the hippocampi, cephaloceles, and ventricular dilation. No correlation between imaging findings and genotype was detected.
